Women and their birth partners’ experiences following a primary postpartum haemorrhage: a qualitative study

Abstract

BackgroundPostpartum haemorrhage (PPH) is a common obstetric complication. Rates of PPH are increasing in a number of developed countries. This is concerning as PPH is recognised as a leading cause of maternal morbidity and mortality which includes psychological and emotional distress. There is limited understanding of the emotional impact of PPH experienced by women and their birth partners. This study qualitatively describes the experiences of women and their birth partners who experienced a primary PPH.MethodsSemi-structured interview study. Couples were recruited via maximum variation sampling, which, by purposive sampling drew participants from three groups depending on the degree of PPH: minor (500–1000 ml), moderate (1000–2000 ml) and severe (>2000 ml). Interviews took place from 4 to 14 months post birth, and data were analysed via Framework analysis.ResultsIn this qualitative study, 11 women and six partners were interviewed. Data were organised into four interrelated themes; Control, Communication, Consequence, Competence. Just over half of the women and their birth partners were unaware they had a PPH, and would have preferred more information either at the time or in the postnatal period. The findings suggest that birth partners also required more information, especially if separated from their partner during the PPH.ConclusionsThis study provides valuable insights into women’s reports of their feelings and experiences during and after a PPH, and how their partners feel having observed a PPH. This study suggests that women who have had a PPH of any volume would like more information. Further investigations into the timings, methods and effectiveness of discussions following a PPH are recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0870-7) contains supplementary material, which is available to authorized users.

What women think about consent to research at the time of an obstetric emergency: a qualitative study of the views of a cohort of World Maternal Antifibrinolytic Trial participants

“…Most were largely unaware that they had been part of a research study, until approached to participate in this study. This is similar to the experiences of parents whose children were entered into emergency research and existing studies of women's experiences of PPH . This loss of memory may, in part, reflect the response of the brain to perceived trauma .…”

A qualitative inquiry into women’s experiences of severe maternal morbidity

“…When the SMM event unfolded as an emergency, as in the case of a postpartum haemorrhage, partners were forgotten as health practitioners focussed on saving the woman's life (Snowdon et al 2012;Dunning et al 2016). Selma's husband was present throughout her SMM event, including being in theatre for her caesarean, but he was essentially a passive observer.…”

“…System improvements in maternity care will therefore help reduce the severity of SMM events. In recent years there has been an increase in qualitative studies of women's SMM experiences, in recognition that patients' experiences can inform these system improvements ( Hinton et al 2014;Dunning et al 2016). Findings from these studies are described next.…”

“…The emergency associated with a SMM event can leave women feeling out of control (Dunning et al 2016) and powerless (Meaney et al 2016). From their synthesis of 12 qualitative studies of SMM, Furata et al (2014) found that women felt safer when they trusted their health care team, even when there was little communication with them during the emergency.…”

“…A SMM event often leads to separation of mother and baby as one or both are admitted to critical care, leaving women unable to fully care for their babies (Knight et al 2016). Dunning et al (2016) found that information about their SMM may help; for example, letting women who have experienced a postpartum haemorrhage know they may have difficulty breastfeeding may go some way to restoring women's 'faith' in their bodies (Fenech and Thomson 2014). Being transferred out of critical care and encountering hospital staff who did not understand what they had been through was hard for women when they were still struggling to care for their baby (Hinton et al 2015;Meaney et al 2016).…”