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

doi:10.1136/ bmjgh-2023-014821

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

Women & Children's Health

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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 language	English
Article number	e014821
Pages (from-to)	1-12
Journal	BMJ Global Health
Volume	9
Issue number	6
DOIs	https://doi.org/10.1136/ bmjgh-2023-014821
Publication status	Published - 25 Jun 2024

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/ bmjgh-2023-014821

Gazeley et al., (2024) - Postpartum recovery after severe maternal morbidity in Kenya - BMJ Global HealthFinal published version, 548 KB

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Gazeley, U., Ochieng, M. C., Wanje, O., Koech, A., Mwashigadi, G., Barreh, N., Kombo, A. M., Bakari, M., Maitha, G., Silverio, S. A., Temmerman, M., Magee, L., von Dadelszen, P., Filippi, V., & The PRECISE Network (2024). Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: A Grounded Theory of recovery trajectories beyond 42 days. BMJ Global Health , 9(6), 1-12. Article e014821. https://doi.org/10.1136/ bmjgh-2023-014821

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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.",

keywords = "Severe maternal morbidity, maternal near-miss, postpartum recovery, postnatal care, grounded theory",

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

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.",

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Gazeley, U, Ochieng, MC, Wanje, O, Koech, A, Mwashigadi, G, Barreh, N, Kombo, AM, Bakari, M, Maitha, G, Silverio, SA, Temmerman, M, Magee, L , von Dadelszen, P, Filippi, V & The PRECISE Network 2024, 'Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: A Grounded Theory of recovery trajectories beyond 42 days', BMJ Global Health , vol. 9, no. 6, e014821, pp. 1-12. https://doi.org/10.1136/ bmjgh-2023-014821

TY - JOUR

T1 - Postpartum recovery after severe maternal morbidity in Kilifi, Kenya

T2 - A Grounded Theory of recovery trajectories beyond 42 days

AU - Gazeley, Ursula

AU - Ochieng, Marvine Caren

AU - Wanje, Onesmus

AU - Koech, Angela

AU - Mwashigadi, Grace

AU - Barreh, Nathan

AU - Kombo, Alice Mnyazi

AU - Bakari, Mwanajuma

AU - Maitha, Grace

AU - Silverio, Sergio A.

AU - Temmerman, Marleen

AU - Magee, Laura

AU - von Dadelszen, Peter

AU - Filippi, Veronique

AU - The PRECISE Network

PY - 2024/6/25

Y1 - 2024/6/25

N2 - 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.

AB - 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.

KW - Severe maternal morbidity

KW - maternal near-miss

KW - postpartum recovery

KW - postnatal care

KW - grounded theory

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DO - 10.1136/ bmjgh-2023-014821

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JO - BMJ Global Health

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

Abstract

Keywords

UN SDGs

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