Journal of Midwifery and Reproductive Health

Journal of Midwifery and Reproductive Health

The Effect of Perinatal Educational Empowerment of Women and their Key Supporters on Perceived Social Support and Postpartum Depression: A Quasi-Experimental Study

Document Type : Original Research Article

Authors
Sakineh Nazari 1
Hamid Alavi Majd 2
Sepideh Hajian 3
1 Associate Professor, Department of Midwifery, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, North Khorasan, Iran
2 a) Professor, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran b) Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Professor, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22038/jmrh.2025.81154.2428
Abstract
Background & aim: Postpartum care is an important factor in improving mothers' performance. One effective strategy for improving postpartum services is participatory health promotion training. This study was conducted to examine the effect of perinatal educational empowerment of women and their key supporters on perceived social support and postpartum Depression.
Methods: A quasi-experimental study was conducted on 178 women in the perinatal period using multistage sampling from July 2020 until February 2021 in Bojnurd, Northeast Iran. Four online sessions of self-care training were conducted for mothers and their key supporters. The duration of each session varied from 30 to 100 minutes, depending on the participants’ needs. Hopkins Perceived Social Support and Edinburgh postpartum depression scales were completed at two and eight weeks postpartum. Data were analyzed using the independent t-test.
Results: No significant difference was found in perceived social support between the intervention and standard care groups at two weeks (81.07±22.94 vs. 78.32±17.38; P=0.380) or eight weeks postpartum (76.32±18.08 vs. 76.53±17.96; P=0.938), although perceived social support decreased significantly over time in both groups (P=0.002 and P=0.025). Postpartum depression rates did not differ significantly between groups at two weeks (18.9% vs. 13.6%) or eight weeks (7.8% vs. 6.8%), but the reduction within the intervention group was significant (P=0.013).
Conclusion: Although the educational empowerment did not significantly improve social support or depression compared with standard care, but it significantly reduced postpartum depression within the intervention group over time. Further studies with larger sample size and longer follow-up are needed to confirm these findings.
Keywords
Empowerment
Perceived Social Support
Postpartum Depression
Postpartum
Subjects
1.        Rezaie Keikhaie K, Nakhaee Moghadam M, Faal Siahkal S, Arbabi H, Koochakzai M. Non-pharmacological postpartum interventions for management of maternal stress in postpartum period: A systematic review of clinical trials. Medicine (Baltimore). 2026; 20; 105.
2.        Cunningham FL, Bloom S, Hauth J, Rouse D, Spong C. Williams obstetrics. 23rd ed. New York: McGraw Hill Medical Publishing;  2022.
3.        Nazari S, Hajian S, Abasi Z, Alavi Majd H. A Review of Postpartum Care Education and Care Interventions in Iran. Scientific Journal of Kurdistan University of Medical Sciences. 2021; 26(3): 86-104. 
4.        Witkowska-Zimny M, Zhyvotovska A, Isakov R, Boiko DI, Nieradko-Iwanicka B. Maternal Sleeping Problems Before and After Childbirth - A Systematic Review. International Journal of Women's Health. 2024 ; 16: 345-371.
5.        Rasmussen SA, McCarthy M, Houghton C, Matvienko-Sikar K. Women's experiences and perceptions of anxiety and stress during the perinatal period: a systematic review and qualitative evidence synthesis. BMC Pregnancy Childbirth. 2021; 21(1): 811.
6.        Mohammadian B, Bakhtiarpour S, Naderi F, Dasht Bozorgi Z. The relationship between perceived stress and postpartum depression through the mediating role of marital satisfaction in postpartum women. Journal of Research Development in Nursing & Midwifery. 2025; 22(1): 7-12
7.        Abdollahpour S, Keramat A. The Impact of Perceived Social Support from Family and Empowerment on Maternal Wellbeing in the Postpartum Period. Journal of Midwifery & Reproductive Health. 2016; 4(4): 779-787.
8.        Maleki-Saghooni N, Amel Barez M, Karimi FZ. Investigation of the relationship between social support and breastfeeding self-efficacy in primiparous breastfeeding mothers. The Journal of Maternal-Fetal & Neonatal Medicine. 2020 Sep 16;33(18):3097-102.
9.        Huang H, Tabb KM, Cerimele JM, Ahmed N, Bhat A, Kester R. Collaborative Care for Women With Depression: A Systematic Review. Psychosomatics. 2017; 58(1): 11-18.
10.    Klatter CK, van Ravesteyn LM, Stekelenburg J. Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review. Archives of Women's Mental Health. 2022; 25(6): 1029-1039.
11.    Tessema M, Abera M and Birhanu Z, Improving postnatal social support using antenatal group-based psychoeducation: a cluster randomized controlled trial. Frontiers in Global Women's Health. 2025; 6: 1510725.
12.    Shrestha T, Pudasainee-Kapri S, Kapri K. Association of postpartum depression and social support with parenting self-efficacy among postpartum women in Nepal. BMC Pregnancy Childbirth. 2026; 26(1): 764. 
13.    Peng D, Chang L, Liao T, Mohd Zain N, Kadir AA, Yan M, Yusuf A. Role of psychological resilience and social support in perinatal depression: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2026; 8. 
14.    ‏Sharifipour F, Javadnoori M, Behboodi Moghadam Z, Najafian M, Cheraghian B, Abbaspoor Z. Interventions to improve social support among postpartum mothers: A systematic review. Health Promot Perspect. 2022; 12(2): 141-150.
15.    Turrentine M, Ramirez M, Monga M, Gandhi M, Swaim L, Tyer-Viola L, et al. Rapid deployment of a drive-through prenatal care model in response to the coronavirus disease 2019 (COVID-19) pandemic. Obstetrics & Gynecology. 2020; 136(1): 29-32.
16.    Chaput KH, Freeman M, McMorris C, Metcalfe A, Cameron EE, Jung J, et al. Effect of Remote Peer-Counsellor- delivered Behavioral Activation and Peer-support for Antenatal Depression on Gestational Age at Delivery: a single-blind, randomized control trial. Trials. 2023; 24(1): 240.
17.    Duffecy J, Grekin R, Hinkel H, Gallivan N, Nelson G, O'Hara MW. A Group-Based Online Intervention to Prevent Postpartum Depression (Sunnyside): Feasibility Randomized Controlled Trial. JMIR Mental Health. 2019; 6(5) :e10778.
18.    Ghiasvand F, Riazi H, Hajian S, Kazemi E, Firoozi A. The effect of a self-care program based on the teach back method on the postpartum quality of life. Electron Physician. 2017; 9(4): 4180-4189.
19.    Dagla C, Antoniou E, Sarantaki A, Iliadou M, Mrvoljak-Theodoropoulou I, Andersson E, Dagla M. The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus. Nursing Reports. 2023; 13(1): 243-254.
20.    Gharaei T, Amiri Farahani L, Haghani SH, Hasanpoor-Azghady SB. The Effect of the Education of Grandmothers on Their Attitude toward Breastfeeding. Iran Journal of Nursing. 2019; 32(119): 59-69.
21.    Corbett GA, Milne SJ, Hehir MP, Lindow SW, O'connell MP. Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020; 249: 96-97.
22.    Mohammadi E. Design and evaluation of collaborative care model to control high blood pressure. [Thesis]. Tehran, Iran: Tarbiat Modarres University, 2001.
23.    Mehran N, Hajian S, Simbar M, Alavi Majd H. Spouse’s participation in perinatal care: a qualitative study. BMC Pregnancy and Childbirth. 2020; 20(1): 489.
24.    Nazari S, Hajian S, Abbasi Z, Majd HA. Postpartum care promotion based on maternal education needs: A mixed study. Journal of education and health promotion. 2021; 10: 261.
25.    Ebadi A, Zarshenas L, Rakhshan M, Zareiyan A, Sharifnia S, Mojahedi MJ. Principles of scale development in health science. Tehran: Jame-E-Negar. 2017; 6(1): 402.
26.    Gray JR, Grove SK, Sutherland S. Burns and grove's the practice of nursing research-E-book: Appraisal, synthesis, and generation of evidence: Elsevier Health Sciences; 2016.
27.    Hopkins J, Campbell SB. Development and validation of a scale to assess social support in the postpartum period. Archives of Women’s Mental Health. 2008; 11(1): 57-65.
28.    Salari P, Nazari S, Mazlum R, Ghanbari Hashem Abadi BA. Comparing postpartum stressors and social support level in primiparous and multiparous women.  Journal of Midwifery and Reproductive Health. 2014; 2: 71-76. [Persian]
29.    Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry. 1987; 150: 782-786.
30.    Montazeri A, Torkan B, Omidvari S. The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version. BMC Psychiatry. 2007; 7(1): 11.
31.    Sarafino, EP & Smith, EP, Health psychology: Biopsychosocial interaction, New York, Wiley, 2014.
32.    Norazman CW, Lee LK. The influence of social support in the prevention and treatment of postpartum depression: An intervention-based narrative review. Women's Health. 2024; 20: 17455057241275587.
33.    Mohammadpour M, Mohammad-Alizadeh Charandabi S, Malakouti J, Nadar Mohammadi M, Mirghafourvand M. Effect of counselling with men on perceived stress and social support of their pregnant wives. Journal of Reproductive and Infant Psychology. 2022; 40(2): 118-132.
34.    Grote NK, Katon WJ, Russo JE, Lohr MJ, Curran M, Galvin E, Carson K. collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial. Depression and Anxiety. 2015; 32(11): 821-834.
35.    Fathnezhad Kazemi A, Sharifi N, Simbar M. A review on different aspects of men's participation in antenatal care. Jorjani Biomedical Journal. 2017; 5(1): 13-19.
36.    Baghersad Z, Mokhtari F, Bahadoran P. Effect of postpartum home care on mothers’ health', The Iranian Journal of Obstetrics, Gynecology and Infertility. 2020: 23(4): 45-53.
37.    Mohammad-Alizadeh-Charandabi S, Malakoti J, Sohrabi F, Shokranian N.The effect of telephone support on postpartum depression: a randomized controlled trial. Journal of Caring Sciences. 2013; 2(2): 147–155.
38.    Gausman J, Langer A. Sex and Gender Disparities in the COVID-19 Pandemic. Journal Womens Health (Larchmt). 2020;  29(4): 465-466.
39.    Molgora S, Accordini M. Motherhood in the time of coronavirus: the impact of the pandemic emergency on expectant and postpartum women’s psychological well-being. Frontiers in psychology. 2020; 11: 567155.
Journal of Midwifery and Reproductive Health
Volume 14, Issue 4
Autumn 2026
Pages 5696-5707