1. Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: a grounded theory of recovery trajectories beyond 42 days
- Author
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Sanjeev Krishna, Jing Li, Andrew Shennan, Prestige Tatenda Makanga, Helena Boene, Marianne Vidler, Laura A Magee, Esperanca Sevene, Peter von Dadelszen, Eusébio Macete, Anifa Vala, Salésio Macuacua, Sónia Maculuve, Jane Sandall, Aris Papageorghiou, Veronique Filippi, Lucilla Poston, Sergio A Silverio, Lucy Chappell, Melisa Martinez-Alvarez, Geoffrey Omuse, Guy Whitley, Hannah Blencowe, Rachel Craik, Carla Carrilho, Marleen Temmerman, Kelly Pickerill, Angela Koech Etyang, Anna Roca, Donna Russell, Umberto D’Alessandro, Hawanatu Jah, Andrew Prentice, Brahima Diallo, Patricia Okiro, Corssino Tchavana, Lazaro Quimice, Inacio Mandomando, Liberty Makacha, Rachel Tribe, Sophie Moore, Tatiana Salisbury, Ben Barratt, Alison Noble, Joy Lawn, Matt Silver, Judith Cartwright, Domena Tu, Marie-Laure Volvert, Laura Magee, Reason Mlambo, Ursula Gazeley, Marvine Caren Ochieng, Onesmus Wanje, Grace Mwashigadi, Nathan Barreh, Alice Mnyazi Kombo, Mwanajuma Bakari, Grace Maitha, Abdul Sesay, Sambou Suso, Baboucarr Njie, Fatima Touray, Yahaya Idris, Fatoumata Kongira, Modou F S Ndure, Lawrence Gibba, Abdoulie Bah, Angela Koech, Consolata Juma, Joseph Mutunga, Isaac Mwaniki, Moses Mukhanya, Marvin Ochieng, Emily Mwadime, Hiten Mistry, Thomas Mendy, Joseph Waiswa, Jeff Bone, Woo Kinshella Mai-Lei, Ash Sandhu, and Yorro Bah
- Subjects
Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Introduction The burden of severe maternal morbidity is highest in sub-Saharan Africa, and its relative contribution to maternal (ill) health may increase as maternal mortality continues to fall. Women’s perspective of their long-term recovery following severe morbidity beyond the standard 42-day postpartum period remains largely unexplored.Methods This woman-centred, grounded theory study was nested within the Pregnancy Care Integrating Translational Science Everywhere (PRECISE) study in Kilifi, Kenya. Purposive and theoretical sampling was used to recruit 20 women who experienced either a maternal near-miss event (n=11), potentially life-threatening condition (n=6) or no severe morbidity (n=3). Women were purposively selected between 6 and 36 months post partum at the time of interview to compare recovery trajectories. Using a constant comparative approach of line-by-line open codes, focused codes, super-categories and themes, we developed testable hypotheses of women’s postpartum recovery trajectories after severe maternal morbidity.Results Grounded in women’s accounts of their lived experience, we identify three phases of recovery following severe maternal morbidity: ‘loss’, ‘transition’ and ‘adaptation to a new normal’. These themes are supported by multiple, overlapping super-categories: loss of understanding of own health, functioning and autonomy; transition in women’s identity and relationships; and adaptation to a new physical, psychosocial and economic state. This recovery process is multidimensional, potentially cyclical and extends far beyond the standard 42-day postpartum period.Conclusion Women’s complex needs following severe maternal morbidity require a reconceptualisation of postpartum recovery as extending far beyond the standard 42-day postpartum period. Women’s accounts expose major deficiencies in the provision of postpartum and mental healthcare. Improved postpartum care provision at the primary healthcare level, with reach extended through community health workers, is essential to identify and treat chronic mental or physical health problems following severe maternal morbidity.
- Published
- 2024
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