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Background: Maternal 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. Methods. This 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. Results: The 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). Conclusion: Uterine 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. © 2014 Kaye et al.; licensee BioMed Central Ltd.
This project involved research on women who ‘nearly died’ of pregnancy-related complications, but somehow survived, hence called near-miss morbidity. The study was conducted in Mukono, Wakiso and Mpigi districts of Central Uganda, from June 1, 2013 to August 30, 2013. The theoretical framework used to explore the meanings attached by survivors to this experience was adapted from Souza et al. [22], which was developed from the definition of a maternal near miss[23,24]. Conceptually, maternal near misses represent a point on a continuum between extremes of good health and death, where mothers develop severe obstetric morbidity and somehow survive, either due to luck or the health care they receive. Such individuals may eventually recover, become temporarily or permanently disabled or die [22-24]. The World Health Organization has developed tools [24] which could be used to identify maternal near misses. These tools utilize a combination of clinical signs/symptoms, management practices or presence of organ dysfunction. The analysis was informed by the concept of health (a state of complete physical, social, psychological and spiritual well-being, and not merely the absence of disease or infirmity). A qualitative study design was chosen to investigate the lived experiences of women with history of uterine rupture during childbirth. This paper analyses findings these intermittent in-depth interviews with 16 women who survived a clinically defined ‘near-miss’. These interviews were conducted as part of a prospective longitudinal study, which was a post-doctoral research project of the first author (DKK) entitled: Evaluation and surveillance of the impact of maternal and neonatal near-miss morbidity on the health of mothers and infants in Jinja and Mulago hospitals. The goal of the project of this mixed-methods study is to assess preventable factors associated with maternal and neonatal near miss morbidity, from the perspective of patients and healthcare providers. Purposive sampling was used to select 16 participants who had uterine rupture during childbirth. Potential research participants were recruited from Mulago hospital at the time of childbirth, at which time they were requested to participate in an ongoing study. Telephone contacts and residential addresses were obtained from them during their hospital stay. Using contact addresses and directions obtained from the participants during this initial contact, the participants were traced to their individual villages and communities, where a second in-depth interview was conducted at a venue chosen by the participant, 3–6 months after the initial interview. Unstructured interviews were employed in order to enable the participants to express their views freely and the meanings they attached to their experiences. To clarify the questions, an interview guide (Table 1) was used. There was some flexibility in the order of questions and in the prompts employed to enhance understanding of the unique experiences of the participants. With the permission of the participants, the interviews were audiotaped in the local dialect (Luganda) and later translated into English. A journal was kept for recording detailed field notes about the cultural and contextual incidents that were heard, seen, experienced, and thought about during the process of data collection, in order to better comprehend and interpret the content of the interviews. Interview guide on lived experiences of women with uterine rupture Thematic analysis was employed. This entailed reading and rereading transcribed interviews to gain insight and deeper meaning in order to identify themes and categories. The analysis was done concurrently with data gathering, which helped to know what to ask in the next interview and to cross check information from each interview with subsequent participants. This process made it possible to recognize the saturation point at which no new information emerged from the data. Ethical approval to conduct the study was obtained from the Ethics and research committees of Mulago hospital (REC 310–2012), the School of Medicine, Makerere University College of Health Sciences (REC 2012–172) and Uganda National Council for Science and Technology. Permission to conduct the study was obtained from the Department of Obstetrics and Gynaecology, Makerere University. All participants gave written informed consent to be interviewed and to have follow-up assessment for a period of six months after the initial hospitalization. They were also provided with counselling and treatment during this period, which was a follow up of the initial evaluation during their hospitalization (the time during which they had developed uterine rupture).
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