Passing the test of motherhood? Self-esteem development and birth experience in the transition to motherhood: A longitudinal mixed methods study in Finland

Aims To investigate women's childbirth experiences and their relation to self-esteem development in the postpartum year. Design A mixed methods study. Methods Women (N = 125) completed survey questionnaires regarding their self-esteem and childbirth experiences at three time points in 2020-2021: third trimester of pregnancy (T1), 4-8 weeks postpartum (T2) and 1 year postpartum (T3). The survey results were analysed using qualitative thematic and quantitative path analyses with latent change factors. The open-ended answers of the women who demonstrated a change in self-esteem between T2 and T3 were then compared. The STROBE checklist was used as the reporting guideline. Results The quantitatively measured childbirth experiences predicted statistically significantly and positively the changes in self-esteem in the following year. The women described their childbirth stories through three main themes: childbirth as a lived experience, childbirth as a relational event and childbirth as a medical event. On the basis of the thematic analysis, we propose that the relationship between childbirth experience and self-esteem development might only hold for women with extremely positive or negative childbirth experiences. There were mixed results for those women who had mixed experiences, indicating that other factors probably contributed to the changes in self-esteem. Conclusion Childbirth is a pivotal event that may have lasting effects on the mother's self-esteem after childbirth. Especially women with traumatic experiences deserve attention because they are at risk of the most negative consequences. Impact Perinatal services and policy makers must recognize the importance of childbirth experiences in women's well-being and improve their practices. Different cultural models of childbirth should be recognized and supported to facilitate good experiences and prevent traumatic ones. Patient or Public Contribution Service users recruited in Finnish Child Health Centers responded to surveys that were used as data for this study.