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Abstract

Background:

Social support plays a critical role in maternal well-being during childbirth and the postpartum period. Florida’s diverse population and healthcare landscape provide a unique setting to explore how support is received and utilized during hospitalization and postpartum transitions. Understanding these experiences can inform policies and interventions to improve maternal outcomes.

Objectives:

To examine women’s perceptions of social support during hospitalization following childbirth and the postpartum period in Florida birthing hospitals.

Design:

A qualitative study using semi-structured interviews.

Methods:

Participants were recruited through Healthy Start programs and had given birth in a Florida hospital within the past 12 months. Virtual interviews were conducted (June–August 2023) in English, Spanish, or Haitian Creole. Transcripts were analyzed thematically using MaxQDA 2022.

Results:

A total of 163 mothers participated, with an average age of 29.5 years, and were interviewed approximately 2.8 months postpartum. Participants were diverse in race and ethnicity (36.2% White, 35% Black/African American, 32.5% Hispanic/Latino). Most participants reported receiving informational and instrumental support from healthcare providers, family, and community organizations. Emotional and appraisal support were less common. Participants valued continuous monitoring, case management, and referrals, but noted gaps in breastfeeding assistance, pain management, and post-discharge support. Support experiences varied by neonatal intensive care unit status, marital status, language, and race/ethnicity, with some reporting communication barriers and disparities in care. Recommendations included enhanced lactation support, clearer medical communication, and improved resource referrals.

Conclusion:

Findings highlight the importance of comprehensive, patient-centered support. While informational and instrumental support were well received, emotional support and care consistency need improvement. Strengthening staff training, standardizing discharge processes, and expanding postpartum resources could enhance maternal well-being and health outcomes.

Keywords

social support postpartum care hospital-based care maternal health

Introduction

Childbirth and the postpartum period are transformative phases in a woman’s life, marked by significant physical, emotional, and social changes ^1,2. In 2022, there were approximately 3.7 million births in the United States, including 223,433 births in³ Florida.³ With the third highest number of births by state, a diverse population, and varying healthcare landscapes, Florida offers a unique context to examine how social support is received, perceived, and utilized during in-hospital childbirth, discharge, and the transition to the postpartum period. In 2022, Florida recorded 223,433 births,³ of which 35.9% were cesarean deliveries.⁴ Although this represents a decline from 38.1% in 2012, it is still higher than the national average.⁴ These figures reflect not only Florida’s high birth volume but also suggest variability in care practices across the state. Florida’s healthcare system encompasses a range of hospital types and services across urban and rural regions, contributing to differences in how women experience postpartum care and support. These contextual factors highlight the importance of examining how support is perceived and delivered within Florida’s diverse healthcare environment. Insights gained from this examination are critical for developing policies and interventions that enhance maternal support, ultimately leading to better health outcomes and maternal satisfaction across diverse communities.

The quality of care and support a woman receives during the intrapartum and postpartum periods influences her overall health and well-being, as well as that of the newborn.⁵ Social support is defined as the process by which interpersonal relationships protect and promote an individual’s well-being, especially during stressful life events.^6,7 The social support theory, as conceptualized by House (1981), outlines how perceived and received support affects health outcomes through four categories: emotional, appraisal, informational, and instrumental.^6,8,9 These various types of social support are crucial determinants of maternal satisfaction, psychological resilience, and recovery outcomes during and after childbirth.^10,11 As social support decreases the likelihood of mental disorders and improves mental health, thereby leading to increased quality of life.¹² On the other hand, inadequate support has been associated with increased risks of postpartum depression, anxiety, feelings of isolation, and even increased risk of maternal and neonatal morbidity and mortality.^12,13

The post-partum hospital stay following a vaginal childbirth without complications is typically 24 to 48 h, while patients undergoing cesarean section may stay 3 to 4 days. During this brief window, healthcare and allied health providers ensure that the parent and newborn are healthy and prepared to transition home. For decades, per Statute 383.14, Florida Healthy Start has conducted universal prenatal and infant risk screening to identify individuals at risk of poor birth, health, and developmental outcomes (Healthy Start, 2023). Families identified through the screen are offered connection to local supports and services through the Healthy Start CONNECT program. The brief 10-item infant risk screen interview is conducted with every parent following birth (with consent).¹⁴ In hospital settings, social support encompasses the presence and involvement of family members, friends, and healthcare professionals, helping women adjust to life with a newborn. A qualitative study from Ireland found that trusting relationships with healthcare professionals empowered women to make confident decisions during childbirth.^15,16 The extent and nature of social support during hospital deliveries and the postpartum period can vary widely based on health care systems, hospital policies, cultural norms, individual preferences, and health status.¹⁷ These experiences in hospital settings often shape how women engage with postpartum care,¹⁸ which is important because effective engagement is crucial for ensuring optimal maternal and neonatal health outcomes.¹⁹ Hence, it is important to study these two experiences in tandem.

Following discharge, the postpartum period presents new challenges as mothers’ transition to home-based care, balancing infant care, household responsibilities, and their own recovery needs. This transition often requires strong social support networks to ease stress and support physical and emotional well-being.^20,21 Community resources and other relevant agencies are crucial for adequate support during this phase.²² However, limited empirical research explores women’s experiences with social support in specific geographic contexts. It is vital to understand what birthing people need to feel supported during their hospital stay, childbirth, and postpartum journeys. To address this gap, this qualitative study aimed to investigate the experiences of women in Florida birthing hospitals, focusing on their perception of social support during the hospital stay following childbirth and the subsequent postpartum period. Using semi-structured interviews, we intended to identify participants’ experiences with different types of social support and determine key areas for improving social support mechanisms across the state of Florida.

Methods

Evaluation team

Our evaluation team included one public health researcher, an obstetrician-gynecologist, two PhD-trained public health researchers, and five public health graduate students. The team developed a protocol to recruit participants who had given birth at any hospital in Florida within the last 12 months, spoke English, Spanish, or Haitian Creole, and had access to a phone or computer for virtual interviews. The University of South Florida Review Board determined that the study was exempt (Studies 00594 and 003364) as “The IRB determined that the proposed activity does not constitute research involving human subjects as defined by DHHS and FDA regulations.”

Recruitment and scheduling

Local Healthy Start staff recruited participants during postpartum program intake, the initial enrolment into their postpartum care services, which typically occurs within the first several weeks after childbirth. They provided individuals with a recruitment flyer with a link for eligibility verification, consent, and interview scheduling, assisting participants with the online interest survey as needed. Participants were eligible if they had given birth at any hospital in Florida within the last 12 months, spoke English, Spanish, or Haitian Creole, and had access to a phone or computer for virtual interviews. There were no additional exclusion criteria. A Qualtrics survey determined participants’ preferred interview language and collected demographic information, consent, and contact details. English-speaking participants scheduled interviews via Calendly, while non-English speakers emailed the study team to arrange interviews. Participants also provided written consent to participate in the study. Interviews were scheduled through Microsoft Teams and assigned to interviewers daily.

Data collection

The team developed a semi-structured interview guide (included as Supplemental Material), incorporating feedback from subject matter experts at the Florida Perinatal Quality Collaborative and Healthy Start Coalitions. The interview guide was piloted by the interviewers before being finalized. Interviews took place from June 26 to 25 August 2023. Interviewers confirmed participants’ preferred language, demographics, and consent before starting the interviews, which were recorded using Microsoft Teams, Otter.ai, and physical recorders. Before starting each interview, participants were informed of the research objectives and provided with information and verbally provided informed consent. Following each interview, a post-interview Qualtrics survey captured interview details and challenges. Healthy Start monitored interview completion rates and distributed $25 gift cards to participants. Transcripts were edited for accuracy and de-identified by team members, with non-English interviews professionally transcribed and translated.

For this study, “in-hospital support” refers specifically to the support participants described receiving during their birth hospitalization, including labor, delivery, and the immediate postpartum period before discharge. The term “perinatal period” encompasses the time from late pregnancy through the early postpartum months. While we did not collect specific data on the duration of hospital stays, we recognize that participants who experienced neonatal intensive care unit (NICU) admissions may have had longer hospitalizations and distinct support needs. Although NICU status was not systematically tracked in our dataset, these experiences are reflected in the thematic analysis as some (29) participants shared them with us, particularly in the section titled “Impact of Individual Background on Social Support Experiences.”

Social support theory

This study is grounded in the conceptual framework of social support theory,^6,7,9 which categorizes support into four functional types: emotional, informational, instrumental, and appraisal. This model is widely used in health behavior research to understand how interpersonal interactions influence well-being during periods of stress, including the postpartum period. We selected this framework for its relevance to the lived experiences of new mothers navigating complex physical and emotional transitions. While this typology provides a useful structure for organizing support experiences, it may not fully capture the fluid, overlapping, or culturally specific ways support is given and received. Nonetheless, it offers a practical lens for analyzing the forms and sources of support described by participants across diverse backgrounds.

Data analysis

All finalized transcripts (which ranged from 3–16 pages in length) were transcribed verbatim and then translated into English when necessary, and subsequently uploaded into MaxQDA. Team members (JTM, TRF, CNR, RSE, AR, MPG, MN) were thoroughly familiar with the transcripts when they collaboratively developed a codebook draft. A priori codes were based on principles of person and family-centered care, social support theory, disparities, and questions in the interview guide. The full codebook is included as Supplemental Material. All team members provided feedback on the codebook draft. They met to collaboratively code three transcripts at three separate sessions, each resulting in codebook refinement. Team members were assigned the same three additional transcripts to individually code and met to review their coding selections and further refine the codebook. After assigning and reviewing an additional three individually coded transcripts, the team concluded that no further codebook refinement was necessary (a total of 9 transcripts reviewed at this phase). The remaining 154 transcripts were assigned to six coders (TRF, CNR, RSE, AR, MPG, MN), who independently coded approximately 25 transcripts each using the finalized codebook. Following transcript coding, coded segments were exported into Excel files for each parent code, and the team worked collaboratively to synthesize coded segments into themes. Themes were identified through weekly team meetings, where coders discussed patterns across the data. One team member compiled an initial list of themes, which was then reviewed, refined, and finalized through group consensus. This study presents the findings from the segments coded according to the social support theory. The Standard for Reporting Qualitative Research guidelines were followed to prepare this article.²³

We collected all interview data prior to analysis, aiming for geographic and institutional diversity by recruiting participants who had delivered in different regions and hospitals across the state. Data saturation was assessed retrospectively during the thematic analysis phase. As we reviewed and coded all interviews, we observed that additional transcripts yielded no new themes or meaningful variation across participant narratives. Saturation was considered reached when participants’ narratives began to converge and no new major themes or meaningful variations emerged across diverse demographic groups and care settings. This assessment was based on team consensus, grounded in both the depth and consistency of responses and the broad representation achieved across the state. If saturation had not been reached at this point, more interviews would be conducted. This approach aligns with definitions of meaning saturation that emphasize the completeness and stability of thematic findings.²⁴

Results

Of the 261 survey participants who met the eligibility criteria for follow-up interviews and were contacted, 163 participated in interviews between June and August 2023. The participants had an average age of 29.5 years, with most interviews occurring around 2.8 months post-delivery (Table 1). Participants had the option to select all applicable race/ethnicity categories. The majority identified as White (36.2%), followed by Black or African American (35%), and Hispanic/Latino (32.5%). Most participants were married or in a committed relationship (50.3%) and attained some college education or an associate or technical degree (37.4%). Interviews were conducted in three languages: English (82.2%), Spanish (15.3%), and Haitian Creole (1.8%).

Table 1.

Participants’ characteristics.

Characteristic	n (%)(N = 163)
Age
Mean (SD)	29.5 (6.4)
Months since delivery
Mean (SD)	2.8 (2.4)
Race/Ethnicity (select all that apply)
White	59 (36.2)
Black or African American	57 (35.0)
Hispanic/Latino	53 (32.5)
Prefer not to answer	3 (1.8)
Marital status
Married/Committed Relationship	82 (50.3)
Single	75 (46.0)
Separated/Divorce	4 (2.5)
Prefer not to answer	2 (1.2)
Highest level of education
Some College/Associate Degree/Technical Degree	61 (37.4)
High School	47 (28.8)
Bachelor’s Degree	30 (18.4)
Did not complete High School	15 (9.2)
Master’s Degree	6 (3.7)
Doctoral/Professional Degree	2 (1.2)
Prefer not to answer	2 (1.2)
Language of the interview
English	135 (82.8)
Spanish	25 (15.3)
Haitian Creole	3 (1.8)

Participants described receiving social support during their hospital delivery stay, with hospital staff and providers being the main sources of support, supplemented by support from family and community organizations. Informational and instrumental support were the most common forms mentioned, while emotional and appraisal support were less frequently reported. Participants’ experiences are summarized below, and illustrative quotes are presented in Table 2.

Table 2.

Thematic quotes.

Theme/subtheme	Quotes
General Social Support
Continuous and Timely Monitoring and Support	"The nurses really did not just even though their job was to care for these babies, they took a huge it’s like they just go above and beyond. They made sure that the parents felt heard. And not only that, but they taught us so much. You know, we were first-time parents, and they were teaching us how to take care of our babies essentially, but not just babies but three-pound babies. You know, these preemies that take a little extra delicate care, and they were teaching—they just taught us so much and took the time to teach us."—White, 32 years, 3 months post-partum
Impact of Individual Background on Social Support Experiences	"They treated me well as a patient and as an immigrant; they never looked down on me or anything like that [. . .]. If they didn’t speak Spanish, they would find someone to translate from Spanish to English. It made me feel secure.”—non-disclosed, 7 months post-partum
	"When they talked among themselves, no. But when they wanted to ask us something, they asked if we spoke English, and we said no. They told us they didn’t speak Spanish, so we said, "Oh, okay." Then she rolled her eyes and brought a tablet to communicate through an interpreter."—White, 22 years, 1 month post-partum
Missing Social Support and Suggestions for Improvements	"The only thing I would mention is I feel they should get a better system for the NICU stay so that moms can stay the night and dads as well, and there was only one rocking chair. That would be the only improvement. I would suggest getting either like a let-out bed or like another rocking chair for the dad as well."—Black or African American, 25 years, 1 month post-partum.
Informational support
Reliable, Clear, and Consistent Information Access	“. . .because everyone was very good at explaining themselves in a technical more medical way, and also in layman’s terms way so that way, they would ask you questions after and explain. So you didn’t feel like you were just talked to you are part of the conversation and they were very clear with what they needed. And you were told multiple times of the things that these were important. So, that way you didn’t miss the conversation, I guess..”—White, 30 years, 1 month post-partum.
Tailored and Responsive Information Provision	“They did offer help with a lactation consultant. And I actually did take that offer and I had two of them actually come and talk to me and help me and guide me through latching. [baby] wasn’t wanting to latch on at the beginning for the first day. So they did help a lot with that..”—Hispanic, 34, 5 months post-partum.
Ongoing Support and Care Referrals	“Yes, they sent me home well-prepared with plenty of information, and then they connected me with Healthy Start for further support. [. . .] Among all the brochures, they gave me a book that has been very helpful, along with a bag of toys. The book contained basic information on how to bathe the baby, the care I needed to provide, and a month-by-month guide. It’s a comprehensive book that has been incredibly useful. It includes information on how to soothe hiccups, change diapers, handle crying, and manage colic, among other topics”—Hispanic, 27 years, 4 months post-partum.
Mental Health and Emotional Well-being	“The only thing that I would advise is to make a little bit more of an effort to educate moms about postpartum that’s something that I noticed is very difficult and taking care of children and taking care of yourself, when you don’t have that much time to figure out what’s wrong with you and get educated with it, especially postpartum depression, and the anxiety part and the worrying about all the kinds of things that’s going to happen to your children. It’s something that they should at least give a pamphlet or a booklet or something that way where the mother can have a source before leaving the hospital. That’s a concern that I think should be looked at.”—Hispanic, 33 years, 1 month post-partum.
Gaps in Hospital Informational Support and Suggestions for Improvement	“The nurses were very rude. They would just come in and then after I had my baby, I couldn’t sleep, and they would ask me, ‘What’s wrong with you?’ I mean, I just pushed out a child, like, I’m tired, like, they would just come in and wake the baby up when the baby’s sleeping as well. He was asleep because he hadn’t been able to sleep.”—White, 21 years, 1 month post-partum
	“What would have been helpful is [if] the doctor knew I was on a medication, the OB. The specific medication that you know, that the baby could have some minor withdrawal. And never, never did anybody mentioned that he might need an adjustment period in the NICU. This is aside from the meconium aspiration. You know, like so I’m walking into the hospital thinking I’m going to be bringing him home, but if I would have been educated a little bit better, We would have known that the chances of me bringing home would have been very, very minimal right away because he was gonna need that adjustment period in NICU to just make sure he was stable. Nobody disclose that.”—White, 22 years, 1 month post-partum.
Family and Friends as Informational Support	“They never told me how to take care of myself. Everything I’ve done is based on what my mom told me. I ask her all the questions I have. In the hospital, they didn’t tell me anything. They just stitched me up, and my mom asked me if they told me how to take care of myself, but I said no.”—White, 31 years, 2 months post-partum.
Instrumental Support
Tangible resources	“They did. They gave they gave us a lot of a lot of stuff. They gave us a formula we had like, diapers, and we also had, like pads for myself and feeding bottles and Baby Hats, swaddles, they gave us like a big old, a big going home package. It had a lot of stuff”—Hispanic, 25 years, 2 months post-partum.
Practical assistance	“The things that I loved so much about the NICU was that the nurses took time to show me how to do things like they showed me how to swaddle, they showed me how to how to prepare a bottle, even simple things like that, and I’ve been around children my entire life. They taught me how to care for the umbilical cord, you know, things like that. And I that was so wonderful for me. Even with my background knowledge, because I was healing and foggy from everything that I’ve been through. And so it was wonderful to have, like a specialist. Teach me how to do these simple things again, yeah. And I think that would be really influential especially for some of our younger moms that we have.”—White, 31 years, 4 weeks post-partum.
Emotional and Appraisal Supports
Compassionate care and attentiveness	“The nurses were just incredible. I mean, they were so sensitive to the fact of like what I was going through. I mean and just and and told me that all the time just it made me feel good. You know, when you’re going through a hard hard time and people give you props for it or whatever. It’s like you’re having to do this. You’re doing such a great job. They would say those kinds of things to me all the time. The doctors they’re around it on me every single day and got to know me on a personal level. I felt very respected. They asked my opinions and always they always listened to me.”—White, 32 years, 3 months post-partum.
	“When, after the surgery, and I was in my room and I was crying. And you know, when the nurse was like what’s wrong? Are you feeling pain? Do you need some water and whatever and I told her that it wasn’t the pain? It’s just that I’m in a situation with the baby and whatever. And I said and she she seemed like she crying too, like she understands, she talked to NICU, she understands and and then the second day when I was in the NICU to see the baby, I was crying at the NICU and the nurse, I was talking to the nurse and she was crying too, there was tears in her eyes. And, you know, it’s not their child, they are trying not to let it flow like, you know, but they did everything they could in terms of I wasn’t alone."—Black or African America, 25 years, 1 month post-partum.
Mental health and well-being	“. . .they made sure that everything that I needed, the help the like if I feel like I’m coming down with depression or anything they made sure that I can call them back and they would push me to help me in that situation. And ever since I’ve been home from the hospital, I’ve just been like the happiest post person ever. I never, like I haven’t been depressed in this pregnancy, since I had her. My other kids I went through depressions and like, anger. With this one is like, I am happy. But actually provide that help if you need that help. If you feel like you’re going to harm yourself or the baby or you feel like you’re coming down with depression, they provide that help at that hospital and they don’t mind if you call them to get that help. And that’s what I like.”—Hispanic, 33 years, 1 month post-partum

General social support

This section addresses instances of general social support that extended beyond specific categories of instrumental, informational, appraisal, and emotional support. Participants frequently noted that a cohesive and attentive support environment significantly enhanced their overall birthing experience. Many expressed that a knowledgeable and caring medical team contributed to a sense of safety and well-being, providing a foundation of trust and comfort throughout labor and postpartum. The presence of a cohesive support network, including hospital staff, case managers, doulas, and community resources, was essential for a holistic care experience that extended beyond individual interactions. This comprehensive approach made mothers feel recognized and cared for as whole individuals, positively impacting both their physical and emotional recovery.

Continuous and timely monitoring and support

Mothers valued the continuous and timely monitoring provided by nurses, doctors, and support staff, which offered reassurance and ensured that both their needs and their babies’ needs were met. This comprehensive approach included proactive assistance from case managers, social workers, and lactation consultants, as well as referrals to supportive resources beyond hospital care. The involvement of non-hospital programs like Healthy Start and the presence of doulas positively impacted mothers’ experiences by enhancing their support network. Follow-up support, such as community referrals and post-discharge check-ins, was particularly important for mothers with babies in the NICU, helping them transition smoothly to home care. Specialized resources, such as the Ronald McDonald House, provided additional support for families with critically ill children, ensuring their ongoing needs were met.

Impact of individual background on social support experiences

Participants’ social support experiences varied based on individual backgrounds, including NICU stays, marital status, language spoken, immigration status, race/ethnic background, and previous parenting experience. Parents with babies in the NICU generally received more detailed and ongoing support, though some experienced anxiety due to communication issues. Marital status also influenced experiences, with married mothers often reporting stronger support systems than single mothers. Non-English speakers encountered additional communication challenges, though some received language-specific support. Immigrant and non-White participants also expressed different experiences with the hospital staff, ranging from feelings of being ignored or mistreated to facing discriminatory comments and actions that amplified their sense of vulnerability and fear. First-time mothers expressed a greater need for detailed guidance, while those with previous children often required less assistance. Some participants also noted that aspects of their background, such as race, immigration status, or language, contributed to feelings of neglect or differential treatment. This included perceptions of being deprioritized, receiving less thorough communication, or being met with impatience, particularly when language barriers were present.

Missing social support and suggestions for improvements

Some mothers reported gaps in social support, particularly around pain management, breastfeeding assistance, and timely access to community resources. Delays in care, such as administering epidurals and consulting lactation specialists, along with inconsistencies in care quality between weekdays and weekends, led to feelings of being unsupported. After discharge, many mothers–especially those recovering from C-sections–needed continuous at-home support and practical assistance, which was sometimes hindered by slow and bureaucratic referral processes. Participants suggested improvements to address these gaps, including increased availability of lactation consultants with regular check-ins, both during hospital stays and post-discharge. They also recommended enhanced training for staff to ensure attentive, responsive care and clearer communication about medical procedures. Streamlining the referral process to community resources for timely access to housing, financial aid, and other support was also emphasized. Overall, mothers underscored the importance of a smooth transition from hospital to home with continuous, accessible support.

Informational support

Reliable, clear, and consistent information access

Participants generally felt well-supported by the information provided by hospital staff, which helped them make informed decisions about their care. Detailed explanations on treatment options, recovery, and post-procedure care for themselves and their newborn, such as feeding schedules and sleep routines, were particularly valued. Visual aids, including diagrams and videos, simple, jargon-free instructions, and hands-on demonstrations, increased participants’ confidence in managing postpartum care for themselves and their babies. Comprehensive discharge instructions covering medication, physical activity, and post-care procedures were helpful, especially when tailored to individual needs. Access to digital tools, such as apps and 24/7 helplines, allowed participants to review instructions and access information as needed, which some mothers found highly convenient. However, a few participants reported gaps in information on specific procedures, such as potential C-section side effects, and emphasized the importance of consistent information and care protocols across staff and shifts. Having easy access to healthcare providers, receiving prompt, consistent responses from providers, and timely updates about test results and treatment changes were critical for maintaining participants’ confidence and reducing anxiety.

Tailored and responsive information provision

Participants appreciated receiving information customized to their individual needs, especially concerning breastfeeding, pain management, and postpartum care. First-time mothers particularly valued the ability to ask questions and receive immediate, reliable answers–especially as they relied heavily on the hospital and their support networks for referrals and follow-up care–though some expressed unmet expectations in delivery and postpartum support. Many participants highlighted the responsiveness of nurses in supporting baby care, noting that detailed, clear guidance [beyond handouts] was most helpful. NICU nurses were especially praised for their attentiveness and patience, although some parents felt more comprehensive information was needed. Participants appreciated access to specialized professionals, such as physical therapists, nutritionists, and mental health counselors, who provided tailored care and advice based on individual needs. The expertise of nurses, social workers, and lactation consultants was especially valued for their attentive and respectful approach, which reassured participants and encouraged adherence to care instructions. Mothers with infants in the NICU relied on expert support for guidance on their child’s treatment when they couldn’t be present. Overall, mothers valued the tailored and responsive information provided by healthcare providers, whose specialized knowledge and support were central to their positive experiences, though some identified areas for improvement in the depth and consistency of information.

Ongoing support and care referrals

Hospital staff provided valuable guidance on baby care, breastfeeding, nutrition, and postpartum check-ins to support participants’ transition to home care. Referrals to services such as lactation consultants, mental health resources, and community groups were highly valued for facilitating smoother transitions. Consistent follow-up support from nurses and doctors, including clear information on accessing resources like Healthy Start, WIC, and SNAP, was especially beneficial. Community programs and local organizations further supported participants through workshops, consultations, and peer support groups, helping bridge the gap between hospital and home care. These resources, particularly mental health services, were crucial for postpartum adjustment. However, some participants noted a need for hospitals to proactively connect them with community resources before discharge to improve accessibility. Challenges, especially for those in rural areas or with limited mobility, highlighted the importance of better outreach. Together, comprehensive follow-up care, proactive referrals, and accessible community support were integral to participants feeling prepared and supported during the postpartum period.

Mental health and emotional well-being

Participants valued information addressing mental health and well-being, particularly strategies for managing stress and recognizing signs of postpartum depression. Hospitals that provided mental health resources and guidance on balancing baby care with emotional wellness were especially appreciated. One participant shared how the hospital described the emotional changes she might experience during the postpartum period and warned her about postpartum depression. Some participants received follow-up calls to check on their well-being and they valued direct informational support in the hospital, which included guidance for both parents on managing emotions and supporting each other. Overall, attention to mental health was crucial in helping participants navigate the postpartum period.

Gaps in hospital informational support and suggestions for improvement

Participants expressed a need for stronger support as they transitioned home, particularly through additional support groups for mental health, postpartum recovery, and practical assistance. They valued proactive referrals to community resources before discharge, but noted that follow-up on these connections was often lacking. Many mothers, especially first-time parents, reported insufficient guidance on basic baby care and breastfeeding, with a stronger emphasis on the newborn’s needs than their own. Participants suggested clearer, more detailed postpartum instructions and resources for fathers to help support mothers.

Some participants also noted instances of dismissive attitudes and insensitive behavior from nurses, which negatively impacted their experience and left them feeling overlooked. Communication challenges, including inconsistent information and lack of clarity regarding NICU procedures, were additional sources of frustration. Language barriers and limited lactation support added to mothers’ feelings of being unprepared. Additionally, several participants described negative or divergent experiences that affected their sense of support. These included perceptions of neglect, such as delayed responses to care requests, and confusion stemming from inconsistent or contradictory advice from different staff members. These lapses often created anxiety and reduced participants’ confidence in their ability to manage postpartum challenges, particularly among first-time mothers or those with limited English proficiency. Participants recommended hospitals improve consistency in information across staff, assign a designated support person to answer questions, and ensure proactive guidance on newborn care. Overall, mothers called for in-depth, consistent, and respectful informational support to better prepare them for the postpartum period.

Family and friends as informational support

Participants found informational support from family and friends valuable, especially when combined with emotional reassurance. Practical advice on baby care, feeding techniques, and sleep routines, often based on personal experiences, complemented the information received from healthcare providers. Family members with healthcare backgrounds were particularly helpful in bridging informational gaps left by hospital staff. While this support was generally appreciated, some participants questioned the reliability of family advice, especially when it conflicted with professional recommendations. Cultural and traditional knowledge passed down from family members played a unique role, with participants often blending these practices with medical advice to create a balanced approach to postpartum care. Overall, support from family and friends was essential in helping participants manage their care and navigate the postpartum period effectively.

Instrumental support

Tangible resources

Postpartum mothers appreciated receiving tangible support from the hospital, such as self-care items, baby supplies, and formula samples, which eased their transition home. Hospitals also assisted mothers in accessing breast pumps and provided transportation for medical appointments when needed. Community organizations further supported mothers by providing essential baby items, while family and friends offered more practical assistance. Many mothers relied on family and friends for help with transportation, meals, and household chores, which proved invaluable during the postpartum period.

Practical assistance

Mothers valued hands-on guidance from hospital staff, such as nurses and lactation consultants, who provided practical demonstrations and coaching on breastfeeding, swaddling, and self-care techniques, which helped them feel more confident in caring for themselves and their babies. However, some mothers—especially first-time mothers—felt there was a need for more consistent support, particularly with breastfeeding and specific baby care tasks like umbilical cord care and bathing. In some cases, nurses handled tasks without showing mothers how to do them, leaving them feeling underprepared. After discharge, family and friends provided critical practical and emotional support, helping with feeding, changing, and comforting the baby, as well as managing daily tasks. This ongoing help was essential for many mothers as they adjusted to postpartum life.

Emotional and appraisal supports

Compassionate care and attentiveness

Participants emphasized both emotional and appraisal support received from healthcare providers, particularly nurses. Emotional support refers to expressions of empathy, comfort, and presence during distressing moments, such as staff acknowledging mothers’ emotions, offering reassurance, or providing calm, attentive care. Appraisal support, by contrast, involved affirming feedback and validation of participants’ coping, caregiving, or resilience, such as being told they were doing a good job or that their feelings and decisions were appropriate. These distinct yet complementary forms of support contributed to participants feeling recognized, empowered, and emotionally supported.

Mothers consistently described the value of compassionate care and attentiveness. Emotional support made them feel genuinely listened to, especially when navigating emotional distress, unexpected challenges, or NICU stays. In parallel, appraisal support fostered a sense of competence and pride in their parenting roles, particularly when providers acknowledged their efforts or affirmed their decision-making. The empathy and encouragement shown by nurses, such as complimenting mothers on their efforts or validating their emotions, created a positive, supportive environment. Participants appreciated being treated as whole individuals rather than passive patients, and this respectful, affirming approach enhanced their emotional well-being. Inclusion of partners and family members further reinforced this sense of support, helping mothers feel less isolated and more confident in their new roles.

Mental health and well-being

Mothers received mental health support from nurses and medical staff, which included regular check-ins and written resources with contact information for counseling services (informational support described above). This care was especially important for mothers experiencing postpartum depression or recovering from C-sections. While the focus on postpartum depression was appreciated, some mothers wished for a broader emphasis on other mental health needs and clearer guidance beyond written materials. Completing postpartum questionnaires felt challenging for some due to fatigue, and there was a sense that these alone were insufficient to fully address mothers’ mental health needs. Some mothers expressed a need for more compassionate mental health care, particularly as they neared discharge, and felt that their postpartum concerns were not always adequately addressed. They often felt a greater focus on the mother’s well-being during the birth process than in the postpartum period, leaving them feeling isolated and unsupported at a critical time.

Healthy Start provided essential counseling support, while family and friends offered crucial emotional backing, which helped mothers cope with the postpartum experience and manage baby care with more confidence. This support from loved ones fostered a sense of solidarity and reassurance, reducing feelings of isolation. However, mothers who lacked family support reported feeling overwhelmed and stressed, indicating that social support played a vital role in their postpartum adjustment.

These findings reflect the complex and varied ways participants experienced support during the postpartum period. While many described meaningful support from hospital staff, family, and community resources, others reported gaps in care, inconsistent communication, or unmet needs. These differences underscore the need for a more coordinated and consistent approach to postpartum support, which is further explored in the discussion section.

Discussion

Our study explored women’s experiences with social support during childbirth and the postpartum period, identifying hospital staff, family, friends, and community organizations (services they learned about during their hospital stay such as lactation support, Healthy Start, WIC, which they later accessed during the postpartum period) as primary sources of support. Consistent with prior research,^17,25 multiple sources of support contributed to a more positive birth experience, with hospital staff playing a particularly crucial role in providing emotional support, information, and advocacy. However, family dynamics influenced the impact of support from partners and relatives, underscoring the complexity of these relationships in shaping women’s experiences. Within the hospital, support from case managers, lactation consultants, and nutritionists was essential for addressing breastfeeding, postpartum care, and medical needs, especially for first-time mothers. Aligning with previous research,^26,27 participants valued timely and high-quality medical care, clear communication, and continuous monitoring from nurses and doctors, which contributed to a positive birthing experience. Women also placed great importance on receiving assistance with breastfeeding, mental health check-ins, and referrals to community resources such as housing, transportation, and nutrition, further underscoring the need for comprehensive support during the hospital stay. However, some participants reported challenges, including unclear communication and delays in care. Many mothers felt that after birth, the focus shifted entirely to the newborn, leaving their own needs overlooked–particularly true for NICU families, first-time mothers, or those facing language barriers. These groups expressed greater unmet support needs and suggested improved staff training on communication, financial guidance, and community resource connections. Notably, a substantial proportion of participants (46%) identified as single. While the study did not stratify findings by relationship status, it is important to recognize that single mothers may experience distinct postpartum support needs, particularly in the absence of a co-parent. This demographic context should be considered when interpreting the findings and their implications for postpartum care.

Informational support was crucial for decision-making, self-efficacy, and confidence with tailored advice on breastfeeding, pain management, and postpartum care, especially appreciated by first-time mothers. Reflecting findings from earlier studies, practical information reduced anxiety and gave parents a sense of control during childbirth, while trusting relationships with healthcare providers helped address individual needs.²⁸ Access to specialized professionals, such as physical therapists, nutritionists, and mental health counselors was also appreciated. Despite feeling generally well-informed, some mothers reported inconsistencies in information clarity, especially when medical jargon was used, underscoring the need for accessible communication, which is linked to reduced stress and increased satisfaction.²⁹ Mental health support and postpartum depression guidance were highly valued, though follow-up was limited. Research shows that while targeted discharge education can reduce postpartum depression,³⁰ long-term support may be essential for sustained benefits.³¹ Additionally, participants expressed a need for comprehensive discharge information on medications, NICU stays, and community resources like WIC to ease the transition to home care.

While many participants reported receiving valuable informational and emotional support, a subset described more negative experiences that shaped their overall perceptions of care. These included delays in receiving assistance, inconsistent advice from providers, and a perception of inattentiveness, particularly during shift changes or when staffs were less available. Such experiences not only led to feelings of frustration and confusion but also highlighted the need for more coordinated and standardized care practices. Addressing these gaps through improved communication protocols and staff training may enhance the reliability and responsiveness of postpartum support systems.

Instrumental support from family and friends was highly valued by mothers, particularly for baby care, meal provision, and respite. In line with prior studies, family assistance played a critical role in reducing parenting stress and enhancing parental confidence through practical help like housekeeping and childcare.^32,33 This support also encouraged postpartum care attendance, as mothers with higher perceived support were more likely to engage in postpartum services,³⁴ underscoring the importance of practical assistance for maternal well-being. Tangible support from hospitals, such as self-care supplies and transportation, was appreciated but varied across facilities, affecting mothers’ stress levels. Some participants felt healthcare professionals could offer more proactive baby care guidance (e.g., diapering, feeding) rather than responding only when asked, with inconsistent support, leaving some mothers feeling unprepared. Research shows that healthcare professionals trained in practical skills can improve outcomes by providing consistent, hands-on support,³⁵ emphasizing the need for structured guidance. The positive impact of reliable support on maternal mental health is well-documented. Studies indicate that lack of practical assistance increases postpartum depression and anxiety risks, while emotional support helps mitigate these effects.³⁶ Our findings reflect this connection, as mothers with consistent support from family and healthcare professionals reported lower stress and greater confidence, suggesting that comprehensive support networks are vital for navigating early parenthood.

Emotional and appraisal support from family and healthcare providers was crucial to mothers’ experiences. Many participants felt respected and listened to, though some reported a lack of empathy from certain staff, which diminished their sense of support. This respectful, compassionate approach aligns with Respectful Maternity Care principles, emphasizing dignity, involvement in decision-making, and compassionate communication—factors shown to enhance care experiences and maternal well-being.^37,38 Mothers in our study valued feeling supported during childbirth, with continuous emotional support linked to improved outcomes, including fewer cesarean sections and higher satisfaction.^17,39 Familiar, supportive individuals like partners or midwives also enhance the birth experience, particularly for low-risk women.³⁹ Emotional support further benefits infants’ social-emotional development⁴⁰ and protects against postpartum depression.³⁶ Participants called for mental health support beyond routine screenings, consistent with research suggesting that combining emotional support with respectful care and clear communication fosters better mental health and confidence.⁴¹ Integrating emotional and appraisal support into maternity care can foster more empowering and satisfying experiences for mothers and families.

Emotional and appraisal support gaps were particularly evident among participants who felt dismissed or overlooked during moments of emotional distress. While many praised the compassion and attentiveness of hospital staff, others described feeling unsupported or treated impersonally, which may erode trust and contribute to poorer psychological outcomes. These divergent experiences highlight the importance of consistently fostering empathetic and inclusive care environments. Participants with infants in the NICU reported especially high stress levels, often describing how the baby’s medical needs overshadowed their own recovery. These experiences point to a critical need for targeted support for NICU mothers, who may face heightened mental health risks due to separation, uncertainty, and disrupted bonding. Hospital systems should consider implementing separate postpartum mental health check-ins or support pathways for NICU mothers to ensure their emotional well-being is not overlooked. Providing proactive mental health screening, trauma-informed counseling, and accessible follow-up services could help mitigate the emotional toll of NICU-related stress.

These findings suggest several opportunities for enhancing postpartum care practices. Hospitals can strengthen discharge processes by implementing standardized protocols that ensure all patients receive clear, culturally appropriate, and comprehensive instructions prior to leaving the hospital. Staff training initiatives should prioritize consistent communication strategies, trauma-informed care, and culturally responsive approaches that are attuned to the needs of diverse patient populations. Expanding access to in-person interpreter services, lactation consultants, mental health professionals, and case managers is critical to addressing disparities in support, particularly for mothers facing language barriers or elevated risk factors. Given the unique challenges faced by NICU families, hospitals should consider offering separate postpartum mental health check-ins or tailored support services to ensure maternal well-being is not overlooked. In addition, strengthening referral pathways to community-based programs such as Healthy Start, WIC, and housing or transportation support can help ensure continuity of care beyond the hospital stay. These targeted strategies reflect the types of support mothers in this study found most meaningful, while also addressing the gaps that contributed to feelings of stress, confusion, or neglect during the postpartum period.

Strengths

Our study provides valuable insights into women’s experiences with social support during childbirth and the postpartum period. One of the main strengths of this study is the large and diverse sample, which allowed us to capture a wide range of perspectives across different regions and hospital settings in Florida. Including participants who spoke English, Spanish, and Haitian Creole helped reflect the linguistic diversity of the state. Another strength is the use of social support theory to guide both data collection and analysis, which provided a consistent framework for organizing and interpreting participants’ experiences. The collaborative approach to coding and theme development also contributed to the rigor of the analysis. These elements support the credibility of the findings and provide a strong foundation for identifying practical implications to improve postpartum care.

Limitations

While a large sample size improves generalizability, it also requires complex data management, posing challenges in ensuring consistency across the dataset. Recruitment through Healthy Start may have introduced bias, as participants likely had greater engagement with services, potentially narrowing the range of experiences. Additionally, the short data collection timeframe and averaging 9.75-minute interviews limited our ability to conduct in-depth follow-up, possibly overlooking nuanced insights. The brief format was intentional to reduce participant burden and enable participation from a geographically diverse sample during the demanding postpartum period. We also aimed to produce focused, actionable findings that could be readily communicated to hospital partners. While this approach facilitated high engagement and broad representation, it constrained the depth of exploration typically associated with qualitative interviews. The interview guide primarily focused on informational and instrumental support, which provided rich data in these areas but may have led to less exploration of emotional support. Without framing data collection within a social support model, we may not have captured all dimensions of support. Self-reported data also introduces potential social desirability biases and conducting the study in Florida limits generalizability to regions with different cultural or healthcare contexts. As with any study relying on retrospective self-report, participant responses are subject to recall bias. While interviews focused on experiences during the hospital stay and discharge, many participants also reflected on postpartum support in the weeks and months that followed, which may have influenced the accuracy or completeness of recall. Additionally, we did not assess the representativeness of the sample relative to the broader birthing population in the state, and the absence of specific information regarding participants’ NICU admissions may have limited our ability to interpret variations in reported support needs and experiences fully. The cross-sectional design captures experiences at a single point in time, which limits understanding of evolving postpartum support needs.

Conclusion

This study offers valuable insights into women’s experiences with support during childbirth and the postpartum period, highlighting how hospital staff, family, friends, and community organizations can contribute to maternal well-being through informational, instrumental, emotional, and appraisal support. Our findings underscore the importance of comprehensive support systems in fostering positive birth and postpartum experiences. In particular, healthcare professionals play a critical role in delivering compassionate, respectful, and proactive care that promotes both immediate benefits, such as lower stress and higher breastfeeding rates, and long-term mental health. To enhance maternal and infant outcomes, healthcare providers should prioritize addressing mothers’ emotional and informational needs while ensuring practical assistance and clear communication. Continuous, tailored support empowers mothers, builds confidence, and supports overall well-being. Future research should explore how support needs evolve throughout the perinatal period and examine the long-term impact of integrated support systems on maternal and infant health. Strengthening these areas of care will improve experiences and outcomes for both mothers and infants.

Supplemental Material

sj-docx-1-whe-10.1177_17455057251385367 – Supplemental material for The role of social support in shaping maternal experiences during the postpartum hospital stay: A qualitative study

Supplemental material, sj-docx-1-whe-10.1177_17455057251385367 for The role of social support in shaping maternal experiences during the postpartum hospital stay: A qualitative study by Rafaella Stein Elger, Tara R. Foti, Chinyere N. Reid, Maria Pacheco Garrillo, Alimot Afolabi, Amandeep Kaur Ratta, Kimberly Fryer and Jennifer Marshall in Women's Health

Footnotes

Acknowledgements

We would like to sincerely thank the postpartum individuals who participated in this study, the Florida Perinatal Quality Collaborative, and the Florida Association of Healthy Start Coalitions.

ORCID iDs

Rafaella Stein Elger

Tara R. Foti

Chinyere N. Reid

Alimot Afolabi

Ethical considerations

The University of South Florida Review Board determined that the study was exempt (Studies 00594 and 003364) as “The IRB determined that the proposed activity does not constitute research involving human subjects as defined by DHHS and FDA regulations.”

Consent to participate

Participants provided informed consent on two occasions: (1) written when filling out the eligibility survey and (2) verbally before starting the interview.

Consent for publication

Not applicable.

Author contributions

Rafaella Stein Elger led the study development, managed and conducted data collection and analysis, maintained the participant database, and drafted the manuscript. Tara R. Foti and Chinyere N. Reid contributed to study development and data collection methodology, data collection and analysis, and manuscript writing. Maria Pacheco Garrillo conducted all Spanish-language interviews, contributed to data collection and analysis, and assisted in writing the manuscript. Alimot Afolabi contributed to data analysis and manuscript writing. Kimberly Fryer and Jennifer Marshall co-led the study team, oversaw study development, and provided critical review and revisions to the manuscript. Jennifer Marshall served as the lead investigator.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by the Florida Association of Healthy Start Coalitions ECCS Impact Project, funded by the Health Resources and Service Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsement be inferred by HRSA, HHS, or the U.S. Government.

The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Availability of data and materials

The datasets generated during and analyzed during the current study are not publicly available due to ethical and identity considerations.

Supplemental material

Supplemental material for this article is available online.

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