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.