Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Sadie P. Hutson

Committee Members

R. Eric Heidel, Lisa C. Lindley, Tami H. Wyatt


Within the maternity care cycle, the postpartum period garners the least consideration from healthcare providers as the focus shifts to the newborn after childbirth even though the health and functioning ability of the mother likely influences the health of her newborn. Nursing care of postpartum women historically has received limited research attention even though nearly 40% of United States (U.S.) maternal deaths have been found to occur during Days 1 to 41 following childbirth. Cesarean sections, considered major abdominal surgery, account for more than one million annual U.S. births resulting in increased morbidity and weeks longer recovery compared to vaginal birth.The purpose of this study was to investigate the relationship between daily, interactive, nurse-navigated mobile messaging support and the outcomes of postpartum symptom experience and perceived availability of social support in first-time mothers who have unplanned cesarean births. Experienced maternity professional registered nurses, designated Postpartum Nurse Navigators (PPNN), implemented the novel texting intervention in an effort to bridge an existing gap between hospital discharge and follow-up healthcare, often not scheduled until four to six weeks postpartum.Using Symptom Management Theory as a framework, a randomized controlled trial design was employed. Subjects completed three surveys electronically at 2-4 days, two weeks, and four weeks post-birth. The intervention consisted of daily, interactive, patient-focused texting with a PPNN that began the day following hospital discharge and continued until four weeks post-birth. Two PPNNs used decision-tree guidelines developed for the study as well as their clinical expertise when texting with subjects. Subjects interacted with an assigned primary PPNN who assessed general well-being, assisted with navigating postpartum symptoms, and answered questions about breastfeeding, postpartum recovery, and newborn care. The control group received usual care.Forty-one subjects completed the study. Underpowered, data analyses showed no differences between the intervention and control groups on the outcome variables postpartum symptom experience and perceived availability of social support. The majority of first-time mothers expressed satisfaction with receiving the nurse-navigated mobile messaging intervention. Establishing access to a PPNN may hold potential to foster maternal well-being during childbirth recovery and consequently promote a healthy beginning for newborns.

Available for download on Thursday, August 15, 2019

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