What matters to women and healthcare providers in relation to interventions for the prevention of postpartum haemorrhage: A qualitative systematic review

Abstract

Background Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Reducing deaths from PPH is a global challenge. The voices of women and healthcare providers have been missing from the debate around best practices for PPH prevention. The aim of this review was to identify, appraise and synthesize available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH. Methods We searched eight electronic databases and reference lists of eligible studies published between 1996 and 2018, reporting qualitative data on views and experiences of PPH in general, and of any specific preventative intervention(s). Authors’ findings were extracted and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed. Results Thirty-five studies from 29 countries met our inclusion criteria. Our results indicate that women and healthcare providers recognise the dangers of severe blood loss in the perinatal and postpartum period, but don’t always share the same beliefs about the causes and consequences of PPH. Skilled birth attendants and traditional birth attendants (TBA’s) want to prevent PPH but may lack the required resources and training. Women generally appreciate PPH prevention strategies, especially where their individual needs, beliefs and values are taken into account. Women and healthcare providers also recognize the value of using uterotonics (medications that contract the uterus) to prevent PPH but highlight safety concerns and potential misuse of the drugs as acceptability and implementation issues. Conclusions Based on stakeholder views and experiences, PPH prevention strategies are more likely to be successful where all stakeholders agree on the causes and consequences of severe postpartum blood loss, especially in the context of sufficient resources and effective implementation by competent, suitably trained providers.

Influencing Factors for Early Detection and Prevention of Postpartum Hemorrhage in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives.

“…Our results showed indication that participants had some knowledge about PPH and the consequences of excessive blood loss at childbirth. This nding concurs with Finlayson et al, [6], who conducted a qualitative systematic review appraising available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH. They found that women were generally aware of the consequences of a severe PPH, but in some situations relied on traditional healers to manage potential childbirth complications.…”

“…Actions taken to address risks prior to onset of a disease (in the case of the present paper PPH), are proactive and constitute primary prevention. A recent qualitative systematic review conducted by Finlayson et al, [6] appraised evidence about the views and experiences of women and healthcare providers on interventions taken to prevent PPH at different prevention levels. The review generated considerable emphasis on contextual factors that contribute to successful implementation of strategies for PPH prevention, especially factors associated with su cient resources and effective implementation by competent, suitably trained providers.…”

Developing and applying a 'living guidelines' approach to WHO recommendations on maternal and perinatal health

“…The updated review includes 196 trials involving 135 559 women 70. In parallel, WHO commissioned new systematic reviews on the views and experiences of women and healthcare providers, PPH prevention interventions and relevant uterotonic cost-effectiveness studies to inform relevant domains of evidence-to-decision frameworks for priority questions 71 72. WHO convened the PPH guideline panel for two virtual meetings (11-12 September and 3-4 October 2018) to review and update the relevant recommendations, which were published on 18 December 2018 40 73…”

Influencing Factors for Prevention of Postpartum Hemorrhage and Early Detection of Women at Risk in The Northern Province of Rwanda: Beneficiary and Health Worker Perspectives

“…Actions taken to address risks prior to onset of a disease (PPH in the case of the present paper), are proactive and constitute primary prevention. A recent qualitative systematic review conducted by Finlayson et al, [6] appraised evidence about the views and experiences of women and healthcare providers on interventions taken to prevent PPH at different prevention levels. The review generated considerable emphasis on contextual factors that contribute to successful implementation of strategies for PPH prevention, especially factors associated with su cient resources and effective implementation by competent, suitably trained providers [6].…”

“…PPH is commonly de ned as a blood loss of 500ml or more within 24 hours after birth [4,5]. Although there have been concerted initiatives to reduce maternal mortality due to PPH, the issue remains a global challenge [6]. According to WHO [1], the latest available data suggest that fewer than half of all births in several low income and lower-middle-income countries are assisted by a trained midwife, doctor or nurse while in most high-income and upper-middle-income countries, more than 90% of all births bene t from the presence of a skilled birth attendant.…”