Information-hungry and disempowered: A qualitative study of women and their partners' experiences of severe postpartum haemorrhage

Snowdon, Claire; Elbourne, Diana; Forsey, Mary; Alfirević, Z̄arko

doi:10.1016/j.midw.2011.12.012

Cited by 39 publications

(70 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Longer-term support and counselling were felt to be particularly valuable, and yet not always universally available. Other studies in both high7,8 and low-income9,10 settings have identified similar themes, and emphasise the importance of integrated quality care across the whole patient pathway in order to improve the outcomes from severe pregnancy complications.…”

Section: Discussionmentioning

confidence: 81%

Experiences of the quality of care of women with near‐miss maternal morbidities in the UK

Hinton

Locock

Knight

2014

BJOG

View full text Add to dashboard Cite

We undertook a qualitative interview study of women's and their partners’ experiences of severe pregnancy complications. Across the care pathway, women identified a number of examples of good practice that made an important difference to their recovery. There were some areas where women felt the quality of care could be improved, for example during points of transition between higher level and routine care or from hospital to the community. Longer-term support and counselling were felt to be particularly valuable, and yet not always universally available. These results emphasise the importance of integrated quality care across the whole patient pathway.

show abstract

Section: Discussionmentioning

confidence: 81%

Experiences of the quality of care of women with near‐miss maternal morbidities in the UK

Hinton

Locock

Knight

2014

BJOG

View full text Add to dashboard Cite

show abstract

“…[34][35][36][37][38] In addition to their physical recovery, women can experience anxiety, isolation and flashbacks in the aftermath. Birth trauma can have lasting consequences that impact negatively on maternal, infant and family well-being.…”

Section: Worktreamsmentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

View full text Add to dashboard Cite

BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

“…Dentre as complicações mórbidas, muitos estudos (GHAZAL-ASWAD et al, 2013;LUZ et al, 2008;MORSE et al, 2011;SHEN et al, 2013) Um aspecto comum da Morbidade Materna Grave, identificado por diversos estudos (GODOY et al, 2008;RÖÖST et al, 2009;SOUZA et al, 2009;CARVALHEIRA;TONETE;PARADA, 2010;STORENG et al, 2010;ELMIR et al, 2012;SNOWDON et al, 2012;TUNÇALP et al, 2012), é a presença de sentimentos de medo e insegurança, tanto em relação à morte como em relação ao bem-estar do bebê. Segundo os autores, a experiência da…”

Section: Cpavunclassified

“…Morbidade Materna Grave pode ser traumática para a mulher e, até mesmo, para o companheiro como mostrou estudo realizado por Snowdon et al (2012) no Reino Unido.…”

Section: Cpavunclassified

“…A dificuldade de relação com a equipe de saúde e não saber o que estava acontecendo foi mencionado por muitas mulheres como algo ruim, gerador de angústias e ansiedade (WEEKS et al, 2005;GODOY et al, 2008;GODOY et al, Apresentação | 25 2009; RÖÖST et al, 2009;SOUZA et al, 2009;CARVALHEIRA;TONETE;PARADA, 2010;STORENG et al, 2010;JONKERS et al, 2011;SNOWDON et al, 2012;TUNÇALP et al, 2012).…”

Section: Cpavunclassified

See 1 more Smart Citation

Morbidade materna grave: estudo qualitativo sobre a experiência de um grupo de mulheres

Silva¹

View full text Add to dashboard Cite

As taxas de morte materna vêm diminuindo em diversos países como resultado de esforços para atingir o Quinto Objetivo de Desenvolvimento do Milênio, o qual estipulou redução da morte materna no Brasil de 56/100.000 nascidos vivos para 16/100.000 nascidos vivos. Os estudos sobre a Morbidade Materna Grave vêm contribuir para compreensão das causas da morte materna, uma vez que se referem às mulheres que sobreviveram a graves complicações na gestação, parto ou puerpério. Neste contexto, o presente trabalho buscou conhecer e analisar as vivências, por parte de mulheres, em relação a um episódio de Morbidade Materna Grave. Utilizando o método qualitativo, foi possível compreender a vivência subjetiva das mulheres sobre a Morbidade Materna Grave. As mulheres que participaram do estudo foram identificadas durante internação decorrente do estado mórbido, sendo contatadas no hospital. Um segundo encontro foi agendado para realização de entrevista semiestruturada. Foram entrevistadas 16 mulheres que passaram por um episódio de Morbidade Materna Grave. As entrevistas foram transcritas e analisadas, segundo a análise de conteúdo. A análise das entrevistas permitiu identificar quatro temáticas: "gravidez não é doença... mas eu adoeci"; "não estou doente, isso deve ser da gravidez"; tratamento: um mal necessário; superação x alerta constante. As participantes apresentaram uma representação de saúde como ausência de doença e de saúde como algo incapacitante. Essa representação vai ao encontro da dificuldade em identificar os sintomas da morbidade em estágios iniciais, buscando auxílio apenas quando os sintomas estavam em estado avançado e interferindo na rotina das mulheres. A gestação foi representada como uma doença, uma vez que a experiência da Morbidade Materna Grave se sobressaiu à experiência da gestação. A Morbidade Materna Grave foi entendida como uma experiência negativa relacionada às dificuldades do tratamento e hospitalização. Também foi possível identificar nas falas das mulheres a presença de medo, preocupação com o feto, frustração da gravidez idealizada, trauma, mas também aprendizado e um propósito de Deus como aspectos positivos da experiência. Como consequência do evento mórbido, as mulheres relataram maior preocupação com a saúde e mudança em alguns comportamentos que possam evitar uma recaída. Diante esses achados, percebemos a importância de um acompanhamento efetivo no pré-natal e puerpério que possibilite uma maior reflexão sobre saúde e autocuidado, além de oferecer um suporte mais efetivo para as dificuldades e sequelas da Morbidade Materna Grave. Maternal death rates are decreasing in many countries as a result of efforts to achieve the fifth Millennium Development Goal, which stipulates reduction of maternal death in Brazil from 56/100.000 live births to 16/100.000 live births. Studies on the Severe Maternal Morbidity helps to understand the causes of maternal death because it refers to women who have survived serious complications during pregnancy, childbirth or puerperium. In this context, the pre...

show abstract

Information-hungry and disempowered: A qualitative study of women and their partners' experiences of severe postpartum haemorrhage

Cited by 39 publications

References 49 publications

Experiences of the quality of care of women with near‐miss maternal morbidities in the UK

Experiences of the quality of care of women with near‐miss maternal morbidities in the UK

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Morbidade materna grave: estudo qualitativo sobre a experiência de um grupo de mulheres

Contact Info

Product

Resources

About