A qualitative inquiry into women’s experiences of severe maternal morbidity

Figures & data

Table 1. Overview of participants’ SMM experience.

Participant pseudonym	Baby no.	ICU nights	Hosp. nights^a	Brief description of SMM incident^b	Clinical condition
1 Jayden	2nd	2	7	Jayden started bleeding at 7 months. A scan revealed baby was 5 weeks behind in terms of expected development and the placenta was small. She was transferred to a secondary hospital and when ‘things weren’t looking so good’ she was flown to a tertiary hospital where the baby was delivered 8 weeks early by emergency caesarean and admitted to NICU.^c Jayden spent two nights in ICU because she had seizures after delivery. The baby remained in NICU for 6 weeks, at which point they were flown to their local hospital for 1½ weeks where the baby came off most of her medication.	Haematuria antenatally – renal calculus diagnosed Seizure at time of caesarean and post-op – not thought to be eclampsia or epilepsy Baby very growth retarded
2 Leah	2nd	1	5	When Leah was 39 weeks pregnant she went to the hospital for a routine check-up with her midwife. The obstetrician she also saw decided she needed an immediate caesarean as her liver was not doing well. She was found to be suffering from diabetes insipidus. Her veins kept collapsing during the surgery, so the drugs did not work properly and she was temporarily left feeling nauseous, shaking, and unable to hold the baby.	Acute Fatty Liver and Diabetes Insipidus – emergency caesarean section
3 Lori	1st	4–6	11	At 36 weeks Lori’s blood tests were unusual and her oxygen level was low. Tests and scans revealed that she had a big ‘hole in her heart’ that she’d been born with. The doctors were surprised that her organs were healthy and everything was working. She had an emergency caesarean and her tubes were tied as another pregnancy was considered life-threatening. She is now on medication and awaiting a decision about whether her heart can be operated on.	Previously undiagnosed congenital heart defect – septal defect
4 Selma	1st	2	5	Selma went into the hospital when her waters broke early one morning. She was at term and expected a normal delivery. Her labour was induced when it was decided her waters had been broken for too long, and she was given an epidural that afternoon. She then received a second epidural during the following night when the needle of the first one broke. At 9am the next morning she had a caesarean, at which time she haemorrhaged, losing 6 litres of blood, and her uterus was removed.	Emergency caesarean section Haemorrhage and hysterectomy
5 Skye	1st	8	3	Skye said everything had gone well with her pregnancy and baby was induced because she was overdue. She then had a caesarean after 17 hours’ labour and still not being fully dilated. The day after she was feverish and there was pus coming out of her caesarean wound. She was diagnosed with cellulitis wound infection and transferred to intensive care. There she was transfused again, had two CT scans, ultra-sounds and x-rays. It was suggested to her that the infection occurred because she was overweight.	Emergency caesarean section Severe sepsis
6 Samar	2nd	4	11	Samar described the delivery of baby as normal and they were discharged two days after the birth. Then she started getting headaches, experiencing swelling, and her vision blurred. Her husband called her midwife who visited the next morning and found her blood pressure was very high, and she was admitted to the hospital’s emergency department. She was eventually diagnosed with postpartum pre-eclampsia.	Severe pre-eclampsia
7 Tara	1st	–	-	Tara’s baby was delivered at 24 weeks due to pregnancy complications. Tara was flown from her home town to a tertiary hospital and had an emergency caesarean there. The baby was placed in NICU and was later transferred to a tertiary hospital closer to Tara’s home town.	Unknown
8 Violet	1st	1	7	Violet waters broke one evening and the next morning she went into hospital. Nothing was happening and around 2pm it was discovered that her waters hadn’t all broken. After this was done, she was induced and her labour then picked up. The baby was born at 7.45pm that night. Violet had suffered a third-degree tear and was admitted to ICU. While there she haemorrhaged, losing four litres of blood.	Postpartum haemorrhage due to atony and trauma
9 Vanessa	2nd	2	7	Vanessa’s blood pressure was elevated at 33 weeks and she was put on medication by her obstetrician. Other than this her pregnancy went well. One evening in week 36 of her pregnancy baby was particularly active. Vanessa woke up early the next morning with cold sweats, followed by what felt like a ‘very bad period pain’. At the hospital, they could not find baby’s heartbeat and her specialist confirmed that baby had died. The baby was induced but when Vanessa haemorrhaged she had an emergency caesarean.	Pre-eclampsia, placental abruption and disseminated intravascular coagulopathy (DIC)

^aHospital nights were additional to ICU bed nights. A dash in either column indicates missing data.

^bThese explanations of events are derived from participant interviews and their reporting of health practitioner interactions.

^cNeonatal intensive care.

Table 2. Overview of super- and sub-ordinate themes.

Super-ordinate themes	Sub-ordinate themes
From normal to severely unwell	Normal pregnancy
	Crisis
	Impacts of emergency on partners
Being in critical care	Sense of self
	Medical intervention and care
Returning to normal	Going home
	Understanding their SMM event