INTRODUCTION
One of the most important roles of a woman in life is considered to be motherhood. Motherhood brings about multiple changes in the woman’s life, especially physiological, economic, and psychosocial changes. In the postpartum period, in addition to her existing responsibilities, the mother assumes baby-related responsibilities such as the care and safety of her baby, communication with her baby, the realization of her baby’s identity as an individual, and coping with problems. While mothers who receive sufficient social support and healthcare services can perform these responsibilities easily, those who are unable to receive social support may have difficulties. As a consequence, mothers may experience psychological issues such as mood disorders and depression, and thus, they may neglect their self-care and the care of their babies.1-6 The feeling of being cared for and supported which is experienced by mothers who receive postpartum social support increases their sense of bonding, self-esteem, self-management skills, and self-efficacy.7 For the adjustment of the woman to her motherhood roles, her well-being, and her capacity to cope with potential problems, it is highly important for her to receive comprehensive healthcare services which include social support.2,8-10
The purpose of care theories in the field of midwifery is to guide midwifery practices. With the usage of theories, systematic and comprehensive care in midwifery practices can be achieved by including individual-centered approaches rather than task-centered approaches, as well as holistic approaches. Care services provided based on theories and models allow practitioners to reach their targeted goals more easily and achieve successful care outcomes.11 In this context, midwives can provide care to women in the pregnancy and postpartum periods based on the “Mother’s Emotional Well-Being – Deck-Chair Theory” which was developed by Jean Ball with a holistic approach. According to this theory by English midwife Jean Ball, pregnancy and the postpartum period can be viewed as a period of adaptation to a new role.12 In her book Reactions to Motherhood: The Role of Post-Natal Care, Ball stated that for a woman to adapt to motherhood, she needs to be put into an active position, while in addition to physiological factors, psychological and emotional factors in this period are effective in the woman’s adoption of her identity as a mother by motivating her parenthood roles. Accordingly, the mother’s state of well-being is influenced by the care she receives, her environment, her identity, and her experiences. These factors are associated with the care provided by midwives and other occupational groups in obstetric services, the attitudes and resources in society, and the support of family and peers. According to the care model of Ball, midwives should provide care and support to women who are emotionally developing toward a state of well-being and adjustment to motherhood.5,8,12-15
According to Jean Ball (1987), the emotional well-being of a mother is affected by factors such as her self-esteem, self-image, life experiences, satisfaction with parenthood, anxiety levels, environment in the postpartum period, the 4th stage of labor, assessment of the development of her baby, individual care plans, being supported in her nutritional choices, the support she receives from her environment, and her perceived level of family support.5,8,15 Ball showed that an increase in these factors was associated with an increase in the emotional well-being of mothers. She identified three themes that affected the emotional well-being of a postpartum mother, namely the personality of the mother, the support of her family and social environment, and the support of healthcare professionals. Based on these three themes, Ball proposed the deck-chair theory. Accordingly, the bottom part of the chair represents the support and care provided by healthcare professionals, the back of the chair represents the personality traits, living conditions, and experiences of the mother, and the middle part of the chair represents family and social support. If the chair is in balance, this shows that the mother is emotionally well and healthy. That is, in line with the chair metaphor, keeping these factors in balance is important for the postpartum well-being of the mother. If the chair is not placed on solid ground, it sinks when it is sat on, and if its parts are incompatible with each other, even though it supports the mother, it causes discomfort and stress. For a state of complete well-being, all three parts of the chair should be in balance, and the chair should be on solid ground. Furthermore, all factors are interrelated, and balancing the shortcomings of one factor with an emphasis on another will keep the emotional well-being of the mother intact (Figure 1).5,8,13-17
In the context of individual needs in obstetrics, to provide comprehensive and high-quality care, it is needed to develop care standards and appropriate assessment tools for midwives in line with scientific knowledge. The content of this scientific knowledge is founded on “concepts” and “theories”, especially in the fields of behavioral and social sciences. Thus, while developing a measurement instrument, its basis should be a theoretical framework.11 In this study, the deck-chair theory by Jean Ball was adopted as a theoretical framework, and it was determined that the emotional well-being of a mother is dependent on her personality and experiences, social support status, and healthcare support status. Höglund and Larsson (2014) also utilized the deck-chair theory of Jean Ball to plan their study and interpret its results. They concluded that the well-being of women was affected not only by social support but also by professional support.12 In a dissertation study about nursing care activities which was planned based on the deck-chair theory by Ball, Devi (2012) reported favorable results in terms of the satisfaction levels and outcomes of mothers who were provided with care using this approach.18 In the literature review, no study on a measurement instrument for the emotional well-being of mothers developed within a theoretical framework could be encountered.19 Therefore, in this study, it was aimed to develop an instrument to measure the emotional well-being of mothers in line with the deck-chair theory of Jean Ball.