Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: A Grounded Theory of recovery trajectories beyond 42 days

Ursula Gazeley*, Marvine Caren Ochieng, Onesmus Wanje, Angela Koech, Grace Mwashigadi, Nathan Barreh, Alice Mnyazi Kombo, Mwanajuma Bakari, Grace Maitha, Sergio A. Silverio, Marleen Temmerman, Laura Magee, Peter von Dadelszen, Veronique Filippi, The PRECISE Network

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Downloads (Pure)

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.

Original languageEnglish
Article numbere014821
Pages (from-to)1-12
JournalBMJ Global Health
Volume9
Issue number6
DOIs
Publication statusPublished - 25 Jun 2024

Keywords

  • Severe maternal morbidity
  • maternal near-miss
  • postpartum recovery
  • postnatal care
  • grounded theory

Fingerprint

Dive into the research topics of 'Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: A Grounded Theory of recovery trajectories beyond 42 days'. Together they form a unique fingerprint.

Cite this