Lived experiences of women who developed uterine rupture following severe obstructed labor in Mulago hospital, Uganda

Abstract

BackgroundMaternal mortality is a major public health challenge in Uganda. Whereas uterine rupture remains a major cause of maternal morbidity and mortality, there is limited research into what happens to women who survive such severe obstetric complications. Understanding their experiences might delineate strategies to support survivors.MethodsThis qualitative study used a phenomenological approach to explore lived experiences of women who developed uterine rupture following obstructed labor. In-depth interviews initially conducted during their hospitalization were repeated 3–6 months after the childbirth event to explore their health and meanings they attached to the traumatic events and their outcomes. Data were analyzed using thematic analysis.ResultsThe resultant themes included barriers to access healthcare, multiple “losses” and enduring physical, psychosocial and economic consequences. Many women who develop uterine rupture fail to access critical care needed due to failure to recognise danger signs of obstructed labor, late decision making for accessing care, geographical barriers to health facilities, late or failure to diagnose obstructed labor at health facilities, and failure to promptly perform caesarean section. Secondly, the sequel of uterine rupture includes several losses (loss of lives, loss of fertility, loss of body image, poor quality of life and disrupted marital relationships). Thirdly, uterine rupture has grim economic consequences for the survivors (with financial loss and loss of income during and after the calamitous events).ConclusionUterine rupture is associated with poor quality of care due to factors that operate at personal, household, family, community and society levels, and results in dire physical, psychosocial and financial consequences for survivors. There is need to improve access to and provision of emergency obstetric care in order to prevent uterine rupture consequent to obstructed labor. There is also critical need to provide counselling and support to survivors to enable them cope with physical, social, psychological and economic consequences.

Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

“…Generally, women expect to receive care promptly on reaching a health facility; therefore, long waiting times present a significant challenge to accessing health facility-based services [22, 29, 31, 53, 82, 87, 97, 107, 115, 123, 154, 155]. A shortage or absence of drugs and other essential supplies in health facilities were reported in other studies [31, 48, 56, 67, 76, 111, 115, 150, 155, 157, 163, 165–168], and poor referral practices/systems [104, 105, 159, 165] such as referred clients being transported unaccompanied by healthcare staff [89], lack of feedback mechanisms on referred patients [152], and late or no referral [29] hinder efficient patient care and may result in adverse outcomes.…”

Male partners’ perceptions of maternal near miss obstetric morbidity experienced by their spouses

“…The study design was a phenomenological study on coping with acute healthcare crises among male partners of women who experienced obstetric near miss events 4-12 months earlier. These participants were identified through their spouses, who were recruited earlier in a study on maternal near miss [ 8 , 9 ]. All participants gave verbal informed consent and were assured that the information given was confidential, that they were not obliged to join the study, and that their views would be anonymous.…”

“…Such maternal near miss is commonly associated with obstetric complications such as unsafe abortions, eclampsia, obstetric hemorrhage, obstructed labor and sepsis [ 1 - 3 ]. Maternal near miss obstetric events have profound physical, financial and social consequences among poor households [ 4 - 7 ], acting as causes or catalysts of vulnerability [ 8 , 9 ]. In the aftermath of the obstetric event, a vicious cycle of poverty, morbidity, disability and loss of livelihood might ensue for the survivors, whereby high healthcare costs, morbidity and loss of household productivity exacerbate each other [ 4 - 9 ].…”

Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study

“…In developing countries [ 8 ] the incidence is high due to socio economic factors, cultural practices and lack of access to antenatal and intra-partum care. This can be evidenced by the greater number of un-booked obstetric emergencies, often originating from rural areas with poor antenatal care [ 9 ], poor obstetric care [ 10 , 11 ], few comprehensive emergency care facilities [ 2 , 12 ], and poor socioeconomic status of the community [ 6 , 13 ].…”