Background
Maternal morbidity (MM) describes adverse pregnancy-related outcomes, excluding mortality, among the pregnant and postpartum population. It is a concept without a universal definition, and most of the literature consists of clinical definitions rooted within the biomedical model of health. The MM perspectives of women and people with pregnancy experience (WPPE) are less well understood, which has resulted in a recent increase in qualitative research on the topic. However, the literature varies in its descriptions of MM which limits data comparisons across institutions and regions that measure differently.
Objectives
This study aims to a) understand the conditions and events that WPPE conceptualize as MM, b) identify the themes that arise across WPPE’s experiences, and c) produce a schematic representation of how WPPE conceptualize MM.
Methods
A concept analysis adapted from the evolutionary model investigated MM from WPPE’s perspectives. The steps included:
1) Identifying and naming the concept and surrogate terms (synonyms)
2) Data collection: literature search consisting of title/abstract and full-text screenings, appraisal, and chart extraction
3) Identifying the concept’s ‘antecedents’ (events that lead to the concept), ‘attributes’ (events that form concept), and ‘consequences’ (events that result from the concept)
4) Analyzing data using thematic analysis
5) Developing a model of the concept
Results
A literature search identified 40 eligible studies. Analysis of WPPE’s MM perceptions from these studies resulted in a MM concept consisting of four attributes – physical (themes relating to pain, bleeding, and adverse infant outcomes), social (themes relating to financial distress, lack of support, abuse, and mothering), psychological (themes relating to fear and distress), and healthcare-related (themes relating to the provider-patient relationship and healthcare facility). Antecedents that preceded MM included being labelled high-risk, access to care, financial stress, cultural norms, physical symptoms, previous adverse experience, lack of support, lack of information, effects of pregnancy on WPPE’s life, and lack of resources. The consequences that followed MM included continued morbidity, inability or reluctance to conceive again, changes to bodily function, strained relationship with partner, financial stress, and in some instances positive outcomes (e.g., gratitude for surviving, good health of baby).
Conclusions
This study illustrated the concept of MM from WPPE’s perspectives by identifying its antecedents, attributes and consequences. In doing so, it demonstrated that MM as perceived by WPPE encompasses more than physical attributes, which largely form the basis of current classification systems. Incorporating these findings into clinical definitions can help inform health and community care approaches to increasingly meet WPPE’s needs. / Thesis / Master of Public Health (MPH) / Reducing poor maternal health outcomes is a global health priority. An indicator of maternal health is maternal morbidity (MM), which describes adverse pregnancy-related outcomes, excluding death, among the pregnant and postpartum population. However, MM is a concept without a universal definition. There has been a recent increase in qualitative research on the MM perspectives of women and people with pregnancy experience (WPPE), which are less well-understood than clinical MM definitions. Therefore, our aim was to understand the conditions and events that WPPE consider as MM. We collected our data from qualitative studies that interviewed WPPE about their MM experiences and analyzed the data for themes that we presented in a concept model. Our findings resulted in a MM concept consisting of physical, social, psychological, and healthcare-related attributes. Factors from the pre-pregnancy period contributed to WPPE’s perceived MM experiences and postpartum events with long-term consequences were also relevant to their health and wellbeing. Protective factors including having good support and faith increased WPPE’s resilience in the face of unexpected MM events. This understanding of WPPE’s perspectives may support future research and interventions to reflect their needs and improve healthcare approaches to MM.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29114 |
| Date | 11 1900 |
| Creators | Seedu, Tegwende |
| Contributors | D'Souza, Rohan, Anderson, Laura, Murray-Davis, Beth, Seymour, Rebecca, Health Sciences |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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