Mothering sweetness mixed with the bitterness of death: the lived mothering experience of near-miss mothers

The Unmet Needs of Women with Maternal Near Miss Experience: A Qualitative Study

Introduction

A maternal near-miss (MNM) case is defined as "a woman who nearly died but survived from life-threatening pregnancy or childbirth complication". This study was conducted on health care providers and near-miss mothers (NMMs) with the aim of discovering the unmet needs of Iranian NMM.

Methods

In this qualitative study 37 participants of key informants, health providers, NMMs and their husbands were selected using purposive sampling. Semi-structured in-depth interviews were conducted for data collection until data saturation was achieved. Data were analyzed using Graneheim and Lundman conventional content analysis.

Results

The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement the quality of care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerging from 18 sub-categories, were formed from 2112 codes.

Conclusion

Many of the real needs of NMM have been ignored. Maternal health policymakers should provide standard guidelines based on the needs discovered in this study to support the NMMs' unmet needs.

Prospective assessment of mental and physical health of maternal near-miss women: A low-middle-income country's experience

Background

Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around.

Aim

A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries.

Materials and Methods

The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist - Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery.

Results

The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05).

Conclusion

There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.

"Living in a vacuum": Lived experiences of maternal near-miss among women with placenta accreta spectrum

BACKGROUND

Placenta accreta spectrum (PAS) is one of the life-threatening complications of pregnancy, the prevalence of which has increased in parallel with the caesarean section rate.

OBJECTIVE

The purpose of this study was to investigate the experiences of mothers with PAS who have also experienced maternal near miss.

METHODS

The participants of this study included 8 mothers who had experienced near miss due to placenta accreta during the past year, as well as two husbands and two health care professionals. Data collection was done using face-to-face, in-depth virtual and in-person interviews. In this qualitative study, the interpretive phenomenological analysis approach was used to analyse the data.

RESULTS

The superordinate theme that emerged from the lived experiences of the studied mothers is 'Living in a vacuum', which was derived from 3 main themes. The theme of 'distorted identity' is related to the mothers' experience of losing the uterus as a symbol of femininity and nostalgia for the former self. The theme of 'exacerbated exhaustion' indicates the burnout and fatigue perceived by these mothers and has dimensions far beyond the exhaustion caused by performing parenting duties. The third theme, 'a threatened future', reflects these mothers' vague image of the future in terms of health, preservation of life, and the continuation of living together with the husband.

CONCLUSIONS

It seems that mothers with PAS need to be covered by integrated and well-organised psycho-social support from the time they are diagnosed with the complication until long after delivery due to the high potentiality of maternal near miss.

Existential challenges due to severe pre-eclampsia when becoming parents

OBJECTIVES

To deepen the understanding of parents' existential challenges and experiences when having a premature infant due to the mother's pre-eclampsia.

DESIGN

Two empirical studies based on reflective lifeworld research (RLR), were conducted to investigate parents' experiences of having a premature infant due to mother's pre-eclampsia. A further abstraction was possible. The two essences were synthesised into a general structure. Then, a philosophical examination of the existential issues was done using Karl Jaspers' concept of limit situation and health theory outlined by Dahlberg and Segesten.

SETTING

Maternity ward and neonatal intensive care unit.

PARTICIPANTS

Nine mothers and six fathers.

FINDINGS

The findings revealed the experiences of a vulnerable group of parents in the maternity ward and in the neonatal intensive care unit (NICU). The parents faced a paradoxical experience. They experienced mothers' severe illness and in some cases accompanied by the possibility of death, at the same time they experienced the joy of becoming parents. The premature birth and the mother's severe symptoms revealed the intertwinement of biological and existential features. Pre-eclampsia restricted the mothers from fulfilling the major project in their lives: to become real mothers. These experiences were elucidated by the concept of limit situations as suffering, struggle, death, and paradoxes of life as well as the health theory with its biological and existential dimensions.

KEY CONCLUSION

Some parents experienced closeness to death and the beginning of life as almost intertwined. These two fundamental facets of life are connected to existential features and challenges. The study also underlined the antinomies of life; suffering and facing severe illness that could cost both the mother's and infant's lives, and at the same time feeling the happiness of becoming parents.

IMPLICATIONS FOR PRACTICE

Health professionals should know how these experiences affect parents. They should be sensitive when approaching mothers and fathers in such situations. The families' vulnerability must be considered within the physical space of health services. If the parents needs to talk, time and staff should be available to meet their needs.