From preparedness to practice: a longitudinal qualitative study of women’s postpartum recovery behaviours from late pregnancy to six weeks after birth

Women may form plans for postpartum recovery before birth, but those plans are made before they know how childbirth, physical recovery and infant care will shape what is feasible. Existing studies have identified barriers to postpartum health behaviours, yet most focus on a single behaviour or a single postpartum time point. This study examined how recovery behaviours changed within the same women from late pregnancy to six weeks after birth, with particular attention to initiation and maintenance. A longitudinal qualitative study followed women interviewed in late pregnancy, 2–3 days postpartum and at approximately six weeks after birth. The final longitudinal analysis included 20 women with complete data across all three interview waves (60 interviews). Longitudinal thematic analysis combined inductive coding with within-case, case-by-time and cross-case comparison. Health literacy and the Capability, Opportunity, Motivation–Behaviour (COM-B) model were applied only after the empirical longitudinal themes had been developed. Five themes described change across the three time points: antenatal preparation often lacked practical detail; birth reshaped recovery priorities; recovery behaviours began gradually and differed by behaviour; sustaining recovery behaviours depended on fit with daily life; and support needs became more practical and responsive. Decisions about initiating particular practices often involved perceived physical readiness, safety and confidence in technique. Accounts of continuation increasingly addressed how specific practices could fit around infant care, fatigue and daily routines, although these considerations overlapped. Reported maintenance varied between practices, and women described changing needs for practical guidance and responsive professional support. Postpartum recovery is not a single behaviour-change problem. Initiating and maintaining postpartum recovery practices involve distinct but overlapping considerations. Postnatal care should therefore provide stage-matched support: realistic preparation before birth, behaviour-specific guidance during early physical recovery, and responsive follow-up that helps women adapt feasible practices to daily maternal life.