Association Between Maternal Autonomy and Maternal Well-Being During Postpartum Confinement Among Primiparous Women: A Cross-Sectional Study

BACKGROUND: Social support is widely recognized as protective against postpartum depression (PPD) and poor quality of life (QoL). However, postpartum confinement practices may provide substantial support while also influencing maternal autonomy. This study examined whether autonomy-related experiences represent distinct psychosocial factors beyond perceived social support. OBJECTIVE: To investigate the associations of maternal autonomy during postpartum confinement with PPD and QoL, and to examine whether decision-making participation and social restriction showed different patterns of association. METHODS: A cross-sectional study was conducted among 328 primiparous women recruited through convenience sampling from a tertiary hospital in Zhejiang Province, China. Data were collected at 2-6 weeks postpartum through outpatient follow-up and online questionnaires. Perceived social support, maternal autonomy, PPD, and QoL were assessed using self-report scales. Pearson correlations, hierarchical linear regression, and exploratory bootstrap analyses were performed. RESULTS: Higher perceived social support was associated with lower PPD symptoms and higher QoL. After adjusting for social support, decision-making participation remained positively associated with QoL (B = 2.43, 95% CI 1.27-3.59, p < 0.001), whereas social restriction was positively associated with PPD symptoms (B = 0.73, 95% CI 0.33-1.14, p < 0.001). CONCLUSION: Postpartum care should provide support while preserving mothers' decision-making participation and reducing unnecessary restrictions.