The Impact of Mental Health on Postpartum Well-Being Among Multigravida in Hospitals in The Fifth District of Camarines Sur

Introduction

Maternal mental health is a critical global concern, with the World Health Organization reporting that one in five women experiences mental health challenges during pregnancy or within the first postpartum year (WHO, 2022). This issue is particularly severe in lower-income countries, where depression and anxiety rates are twice as high as those in wealthier nations (WHO, 2022). Globally, postpartum depression affects approximately 17.22% of women (Liu et al., 2021). This strain worsened significantly during the pandemic, revealing that mothers managing multiple children face heightened stress and a greater risk of depression while recovering from childbirth (Frontiers in Psychology, 2020). Because untreated maternal mental health conditions can severely disrupt a mother’s well-being, child development, and family stability, international health organizations now heavily emphasize integrating mental health screenings and support directly into standard maternal healthcare programs (WHO, 2022).

In the Philippines, cultural stigmas, economic disparities, and systemic healthcare gaps cause postpartum depression rates to fluctuate widely, affecting anywhere from 16% to 58% of mothers (Smart Parenting, 2025). While national policies like Republic Act No. 11036 and Republic Act No. 10354 legally mandate accessible, affordable, and comprehensive maternal mental health services, implementation remains highly unequal (Official Gazette, 2012). This is especially true in the Bicol Region and Camarines Sur, where geographic isolation, poverty, and a shortage of rural health facilities prevent new mothers from receiving essential prenatal and postnatal mental health checks. Furthermore, deeply embedded cultural traditions, travel barriers, and local stigmas often discourage women in these rural communities from openly discussing their emotional distress or seeking professional help (Labrague, 2020).

At the local level, hospitals in the Fifth District of Camarines Sur serve as a primary healthcare hub, yet its facilities face limited funding, a shortage of specialized mental health professionals, and a lack of culturally appropriate screening tools. The unique challenges of this region are vividly apparent in Intensive Care Unit (ICU) clinical settings, where clinical observations show that untreated postpartum mental illnesses can escalate into severe physical crises, such as postpartum psychosis and medical emergencies stemming from self-neglect. These critical observations highlight how multigravida women are particularly vulnerable due to cumulative physical exhaustion, past births, and heavy caregiving demands. This clinical insight underscores an urgent, systemic need to transition from reacting to emergency crises in the ICU to implementing proactive, preventative mental health screenings within routine local postpartum care.

METHODOLOGY

The study analyzes the collected data using a quantitative descriptive research design. A quantitative descriptive design is a research methodology that focuses on describing and summarizing numerical data in order to provide a thorough and precise representation of the characteristics of a phenomenon or sample. In general, this method seeks to provide a clear and detailed image by collecting and evaluating quantitative data, such as counts or measurements (Creswell, 2021).

In this study, the quantitative descriptive design was useful for systematically and quantitatively examining the perspectives of mothers regarding their mental health and postpartum well-being. Employing this design allows for comprehensive measurement and description of various maternal mental health factors and their influence on postpartum outcomes.

The study respondents were multigravida women in the postpartum phase, confined in hospitals in the 5^th District of Camarines Sur. The total number of respondents was 70, selected through purposive sampling. The respondents were as follows: 10 from Catangui Health and Medical Services Corporation (CHMSC) - Lourdes Hospital; 15 from Medical Mission Group Hospital and Health Services Cooperative of Camarines Sur; 15 from Our Lady Mediatrix Hospital; and 20 from Sta. Maria Josefa Hospital Foundation, Inc., and 10 from Villanueva-Tanchuling Hospital.

The primary data-gathering instrument used in this study was a pre-validated questionnaire checklist. The questionnaire was used to determine the impact of maternal mental health on the postpartum well-being of multigravida women and to identify significant factors influencing their mental health during the postpartum period.

After collating the information from the data-gathering process, the responses were systematically grouped and tabulated according to the different variables included in the study. The data gathered was presented quantitatively with the use of statistical tools specified such as frequency counts, weighted means, and Spearman's rank order correlation.

Results and Discussion

Level of Postpartum Well-being among Multigravida in Hospitals in the Fifth District of Camarines Sur

This section presents the level of postpartum well-being among multigravida in hospitals in the Fifth District of Camarines Sur, across physical, emotional, and social dimensions.

Physical Well-being. Table 1 shows the level of postpartum well-being among multigravida in hospitals in the Fifth District of Camarines Sur, with a focus on physical well-being.

Based on the data, multigravida mothers have a high level of physical well-being, with a perception that the body is healing properly without complications (4.04) and recovering well from childbirth (4.03), sufficient energy for daily activities and overall physical health (3.89), maintaining a healthy diet (3.86), feeling physically strong (3.79), engaging in light (3.70), experiencing minimal pain (3.69) and a regular attendance of postpartum check-ups (3.25), while a moderate level on getting adequate sleep and rest (3.13). Overall, multigravida mothers have a high level of postpartum physical well-being, with an average mean of 3.72.

This suggests that, generally, multigravida mothers in this district perceive their physical recovery and health status positively during the postpartum period. The results indicate a strong sense of physical resilience among multigravida mothers. The high scores in proper healing and recovery may be attributed to the respondents’ multigravida status; having previously experienced childbirth, these women may have developed better physiological coping mechanisms or more realistic expectations of the recovery process compared to primigravida mothers.

However, the moderate score for sleep and rest plays a significant clinical concern. Postpartum fatigue is a well-documented challenge, especially for multigravida mothers who often have to balance their own recovery with the demands of caring for both a newborn and older child.

The finding that sleep disturbance is the weakest indicator of physical well-being is consistent with the current literature. Rao et al. (2023) found that postpartum sleep deprivation is significantly more pronounced among multiparous women, who face simultaneous caregiving demands that substantially reduce sleep duration and quality compared to primiparous mothers. Similarly, Kroll-Desrosiers et al. (2022) demonstrated that physical recovery self-perception tends to be more positive in multigravida women due to prior birth experience, yet objective health measures, particularly sleep adequacy, remain compromised regardless of parity.

Emotional Well-being. Table 2 illustrates the very high level of postpartum well-being among multigravida in the Fifth District of Camarines Sur, specifically emotional well-being, with an average mean of 4.31.

The data show a very high level of postpartum emotional well-being among multigravida, with a positive bond with the baby (4.76) and patients feeling happy and content in their role as a mother (4.53), feeling a sense of fulfillment (4.49), confidence in parenting abilities, and experiencing joy in childcare (4.41). Lastly, having a positive outlook about the future (4.37). On the other hand, there is a high level of postpartum well-being specifically on managing emotions effectively (4.17), emotional stability throughout the day (4.11), overall satisfaction with emotional health (3.91) and the comfort level in expressing feelings to others (3.89).

This indicates that these mothers are experiencing a highly positive psychological transition during the postpartum period. The mothers’ highest levels of satisfaction are directly tied to their relationship with the newborn and to their identity as caregivers. This reflects the high value placed on motherhood in Filipino culture, where the bond with the child often serves as a primary source of emotional resilience.

However, the lower rankings in emotional expression and overall satisfaction with emotional health highlight a subtle discrepancy. While these mothers are deeply bonded with their infants, they may be less focused on their own individual emotional needs or may lack a safe space to verbalize their struggles. This is common, as mothers may feel cultural pressure to appear strong or resilient for the sake of the family.

This pattern is well-documented in cross-cultural postpartum literature. Laney et al. (2023) found that Filipino and other Southeast Asian postpartum women often report high maternal role satisfaction scores while simultaneously underreporting emotional distress, attributing this to cultural norms that valorize selfless motherhood and discourage emotional vulnerability. Relatedly, Osokpo and Riegel (2022) noted that in collectivist cultures, postpartum emotional well-being scores tend to cluster around the maternal role dimension rather than individual psychological health, suggesting that culturally adapted screening tools are needed to capture the full emotional experience of mothers from these communities.

Social Well-being. Table 3 details the high level of postpartum social well-being among multigravida patients in the Fifth District of Camarines Sur.

The data indicate that there is a high level of postpartum emotional well-being, including support coming from family members who assist with childcare and household tasks (4.57), receiving adequate support from a partner (4.34), maintaining healthy relationships (4.33), having friends to talk to about motherhood (4.24) and feeling comfortable asking for help (4.23). Whereas, a high level on satisfaction with the social support network (4.17), access to healthcare professionals (4.06), and feeling understood and validated, and feeling connected to the community (4.01). Lastly, participating in social activities or gatherings (3.83). The high average weighted mean of 4.18 suggests that the social environment in the Fifth District of Camarines Sur provides a solid foundation for postpartum recovery.

The mothers are well cared for at home, which likely explains their high emotional well-being scores reported in previous tables. However, the transition from being a mother at home to a member of the community appears more challenging. The high rank of family assistance reflects the traditional mutual aid system. Multigravida mothers’ benefit from a built-in support system in which older siblings or extended family members lighten the domestic load. However, the higher scores for feeling understood than for receiving help suggest that, while these mothers are receiving physical help, they may still feel a slight gap in empathy or deep validation from those around them.

The data reflect the strength of the extended-family support system (bayanihan and pagtulong) prevalent in communities. Multigravida mothers are embedded in a network where older children, spouses, grandparents, and relatives actively share the domestic load, providing a strong protective social environment for postpartum recovery. However, the lower score for community participation reveals that while these mothers are well-supported within the household, their engagement with the broader community is more limited, a predictable consequence of having a newborn and the demands of managing a multi-child household. The subtle gap between receiving help and feeling understood also implies that the quality of social support, not just its quantity, matters for these mothers.

The centrality of family-based support as the highest-ranked social indicator aligns with findings from Upadhyay et al. (2024), who established that extended family involvement significantly buffers postpartum stress and reduces the risk of postpartum depression among multiparous women in low- and middle-income countries, where informal caregiving networks substitute for formal postpartum care services. Additionally, Dennis et al. (2022) confirmed in a systematic review that perceived social support from partners and family members rather than from healthcare professionals or peer groups is the strongest predictor of positive postpartum social well-being, particularly among women with two or more previous births.

Impact of Mental Health among Multigravida

The succeeding tables illustrate the impact of mental health among multigravida patients in hospitals in the Fifth District of Camarines Sur.

Depression. Table 4 presents the data on the impact of mental health among multigravida in terms of depression.

The result shows that there is a moderate impact of depression on the postpartum well-being of multigravida, as shown by the following symptoms: having trouble falling asleep or staying asleep at night (3.37), feeling sad or down most of the day (3.27), crying more easily or frequently than before (3.19), feeling exhausted even after resting (3.17), changes in appetite (3.16), loss of interest in activities, and difficulty concentrating (3.04), feelings of worthlessness or guilt (2.87), thoughts of being better off not being (2.63), and low impact on feeling hopeless about the future (2.53). Overall, depression has a moderate impact on postpartum well-being, with a mean of 3.03.

The moderate-level depression impact suggests that while these mothers are not in acute psychiatric crisis, they are experiencing a clinically meaningful psychological burden. The dominance of somatic symptoms (sleep, fatigue, crying) over passive ideation aligns with how postpartum depression often presents differently in non-Western populations through physical rather than purely cognitive depressive symptoms. The low score for hopelessness, despite moderate sadness, may reflect cultural and familial coping buffers, particularly religious faith and family cohesion, that prevent the deepening of passive ideation into hopelessness.

The finding that somatic depressive symptoms predominate over passive ideation is supported by Gelaye et al. (2023), who found that sleep disruption is the earliest and most consistently reported symptom of postpartum depression across multiparous populations in Southeast Asia, preceding emotional or cognitive depressive features by several weeks. Furthermore, Lara-Cinisomo et al. (2022) documented that multigravida Latina and Filipino mothers frequently present with sub-threshold depressive symptoms characterized by fatigue and tearfulness rather than hopelessness, and are less likely to be flagged by standard Edinburgh Postnatal Depression Scale (EPDS)-based screening, reinforcing the need for culturally sensitive depression detection in these groups.

Anxiety. Table 5 displays the impact of mental health among multigravida patients, specifically in terms of anxiety.

The data show that anxiety has a moderate to high impact on the postpartum well-being of multigravida. Specifically, anxiety impacts highly multigravida for experiencing physical symptoms like trembling or shaking (3.56), and avoiding situations that cause anxiety (3.53). The following symptoms with moderate impact include: excessive worrying (3.33), difficulty controlling worrying thoughts (3.06), feeling restless or on edge (3.03), feeling a sense of dread (3.00), shortness of breath (2.91), difficulty relaxing (2.89, unexpected heart racing (2.79) and feeling nervous or panicked without reason (2.66). Overall, anxiety has a moderate impact on postpartum well-being with an average mean of 3.08.

The high scores for physical anxiety manifestations and avoidance behavior suggest that postpartum anxiety among these multigravida mothers presents primarily through the body and behavioral responses rather than generalized cognitive worry. The pattern is consistent with somatized anxiety, where psychological distress is expressed through physical sensations, likely because overt emotional distress is culturally less acceptable to express. The avoidance behavior may reflect not cowardice but a pragmatic coping strategy among mothers who manage large households: avoiding stimuli that trigger anxiety is a functional short-term mechanism, though potentially maladaptive in the long term.

Postpartum anxiety's somatic predominance in Filipino and similar contexts is documented by Falah-Hassani et al. (2023), whose meta-analysis identified that in Asian postpartum populations, physical symptoms particularly tremors, palpitations, and hyperventilation, are the primary presenting features of anxiety disorder, often misattributed to postpartum physical discomfort rather than recognized as anxiety. Additionally, Nakić Radoš et al. (2022) found that avoidance coping is significantly higher among multiparous postpartum women than among primiparous mothers, likely because experienced mothers develop a preference for protective routines and stimulus control to maintain household stability.

Stress. Table 6 details the impact of mental health among multigravida patients on stress.

There is a moderate impact of stress on postpartum well-being in multigravida shown by the following symptoms such as: feeling irritable or easily frustrated (3.27), difficulty finding time for self-care (3.21), experiencing headaches or body aches due to tension (3.20), feeling overwhelmed by daily responsibilities with (3.16), feeling pressure to meet maternal expectations (3.11) and having too many things to handle at once (3.09), role conflict between being a mother, partner, and worker (3.06), difficulty managing motherhood demands (2.97), feeling unsupported in responsibilities (2.84) and trouble coping with unexpected challenges (2.81). Overall, the stress has a moderate impact on postpartum well-being, with an average weighted mean of 3.07.

The stress level of these mothers is characterized by emotional reactivity and time poverty. The mothers are not necessarily failing to manage their lives, but the cost of managing them is high irritability and physical tension. The moderate average indicates a simmering level of stress that, while not reaching a crisis point, significantly degrades their quality of life.

The stress impact reveals what may be described as a state of functional overload. Mothers are managing their responsibilities, but at a high cost to their emotional regulation and physical comfort. The dominance of irritability and self-care deprivation as top stressors points to a time-poverty phenomenon: there are simply not enough hours in the day for a multigravida mother to meet all caregiving demands and still attend to herself. The relatively lower scores for feeling unsupported suggest that stress is not primarily relational but structural, arising from the volume and intensity of responsibilities rather than from a lack of help.

These findings are consistent with those of Dagher et al. (2022), who identified that among multiparous women, postpartum stress is most strongly predicted by self-care deprivation and role overload rather than by interpersonal conflict or perceived lack of support, a pattern distinct from primiparous mothers for whom social support deficits drive stress. Correspondingly, Hung et al. (2023) documented that irritability and somatic tension (headaches, muscle aches) are hallmark stress indicators among multigravida postpartum women across Southeast Asian cultures, attributing these to the compounding of newborn care demands on an already established pattern of domestic and caregiving responsibility.

Test of Significant Relationship of Level of Postpartum Well-being and Impact of Mental Health among Multigravida

Table 7 evaluates the correlation between the level of postpartum well-being and the impact of mental health, specifically among multigravida mothers.

The analysis reveals a Spearman's rank correlation coefficient (r_s) computed value of 0.27, which is substantially lower than the critical tabular value of 0.60 required at a 0.05 significance level with 9 degrees of freedom. Consequently, the null hypothesis (H_o), which states that there is no significant relationship between the level of postpartum well-being and the impact of mental health among multigravida, is accepted. Thus, the statistical interpretation confirms that the relationship is not statistically significant.

Experienced, multiparous mothers’ subjective postpartum well-being is not inherently dictated by or directly synchronized with the severe psychological impacts typically measured by mental health assessments. Multigravida individuals have previously traversed the complexities of pregnancy, childbirth, and newborn care, allowing them to accumulate distinct psychological adaptations and coping mechanisms. While a first-time mother may suffer a precipitous decline in postpartum well-being from early perinatal distress, experienced mothers often maintain a steady level of daily functional well-being even when experiencing mild to moderate mental health stressors. This divergence infers that postpartum well-being among multigravida women is multidimensional and decoupled from singular mental health indices, likely buffered by experiential resilience, established family routines, and adjusted parental expectations.

This statistical divergence aligns seamlessly with contemporary maternal healthcare literature, which emphasizes that perinatal experiences vary substantially by parity and socioeconomic factors. Recent epidemiological profiles and longitudinal birth cohorts demonstrate that while multigravida status and larger family sizes can elevate the raw risk of perinatal depression due to compounded socioeconomic disadvantages and childrearing stress, the actual impact on maternal functional well-being is heavily mediated by external factors such as social and paternal support networks (Datta, 2026; Djatche Miafo et al., 2023). Studies addressing the determinants of maternal mental health emphasize that experiential knowledge and strong family support systems act as significant buffers that protect a mother’s day-to-day well-being from deteriorating concurrently with elevated mental stressors (Hayati, 2026; Latifah et al., 2025). Thus, the lack of a direct, statistically significant link reinforces contemporary findings that multigravida mothers utilize unique coping strategies that break the traditional, linear relationship between mental health impact and perceived postpartum well-being.

Postpartum Mental Health Education for Multigravida Mothers

The goal of the "Postpartum Mental Health Education Program for Multigravida Mothers" is to proactively bridge the gap between clinical diagnosis and holistic recovery by strengthening the psychological fortitude of mothers who have undergone multiple pregnancies. The purpose of this output is to dismantle the experienced mother bias, the dangerous assumption that because a woman has given birth before, she is less susceptible to postpartum distress and instead provide her with specialized tools for stress management and emotional regulation. By translating research findings into a structured educational framework, the program serves as a practical intervention to improve maternal well-being, facilitate early detection of postpartum mood disorders, and ultimately foster a healthier domestic environment for both the mother and her growing family in the local hospital setting.

Conclusions

Multigravida postpartum mothers in the Fifth District of Camarines Sur demonstrated very high well-being in the emotional domains and high postpartum well-being on both social and physical aspect.

Mental health in terms of anxiety, stress, and depression has a moderate impact on the postpartum well-being of multigravida hospitals in the Fifth District of Camarines Sur.

There is no statistically significant relationship between the level of postpartum well-being and the impact of mental health among multigravida.

A structured, multi-dimensional Postpartum Mental Health Education Program for Multigravida Mothers is essential to bridge the identified recovery gaps by prioritizing stress reduction, sleep hygiene, and emotional expression protocols. This targeted intervention provides a culturally sensitive, community-based strategy to mitigate pervasive psychological burdens and optimize holistic wellness outcomes for multigravida mothers across the Fifth District of Camarines Sur.