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Cited by 62Maternal and fetal healthcareMaternal and Perinatal Health InterventionsFamily and Patient Care in Intensive Care Units

Maternal critical care: what can we learn from patient experience? A qualitative study

Open access
Hinton, Lisa, Locock, Louise, Knight, Marian·2015·BMJ Open
DOI 10.1136/bmjopen-2014-006676PMC PMC4420959
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Abstract

Objective: For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. Setting: Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity. Design: A qualitative study, using semistructured interviews. Participants: A maximum variation sample was recruited of 35 women and 11 partners of women who had experienced a severe maternal illness, which without urgent medical attention would have led to her death. 18 of the women were admitted to ICU or HDU. Results: The findings are presented in three themes: being in critical care; being a new mother in critical care; transfer and follow-up after critical care. The study highlights the shock of requiring critical care for new mothers and the gulf between their expectations of birth and what actually happened; the devastation of being separated from their baby, how valuable access to their newborn was, if possible, and the importance of breast feeding; the difficulties of transfer and the need for more support; the value of follow-up and outreach to this population of critical care patients. Conclusions: While uncommon, critical illness in pregnancy can be devastating for new mothers and presents a challenge for critical care and maternity staff. This study provides insights into these challenges and recommendations for overcoming them drawn from patient experiences.

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  • Severe maternal morbidity and medical crises have been associated with delayed bonding and early caregiving disruption, including reduced physical proximity and difficulty initiating breastfeeding.

    “Severe maternal morbidity and medical crises have been associated with delayed bonding and early caregiving disruption, including reduced physical proximity and difficulty initiating breastfeeding (53).”

    From Epigenetic changes associated with multi-generational trauma: characterization, mechanisms, and therapeutics (2026) · cites this paper as [53]

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  1. [3]Waterstone M, Bewley S, Wolfe C Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 2001; 322: 1089– 93. 10.1136/bmj.322.7294.1089 11337436 PMC31259 · DOI
  2. [4]Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (eds), on behalf of MBRRACE- UK. Saving Lives, Improving Mothers' Care - Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2014. 10.1111/j.1471-0528.2010.02847.x · DOI
  3. [6]Engstrom A, Lindberg I Mother's experiences of a stay in an ICU after a complicated birth. Nurs Crit Care 2012; 17: 64– 70. 10.1111/j.1478-5153.2011.00474.x 22335347 · DOI
  4. [7]Snowdon C, Elbourne D, Forsey M Information-hungry and disempowered: a qualitative study of women and their partners’ experiences of severe postpartum haemorrhage. Midwifery 2012; 28: 791– 9. 10.1016/j.midw.2011.12.012 22365835 · DOI
  5. [8]Elmir R, Schmied V, Jackson D Between life and death: women's experiences of coming close to death, and surviving a severe postpartum haemorrhage and emergency hysterectomy. Midwifery 2012; 28: 228– 35. 10.1016/j.midw.2010.11.008 21251734 · DOI
  6. [9]Souza JP, Cecatti JG, Parpinelli MA An emerging “maternal near-miss syndrome”: narratives of women who almost died during pregnancy and childbirth. Birth 2009; 36: 149– 58. 10.1111/j.1523-536X.2009.00313.x 19489809 · DOI
  7. [10]Prinjha S, Field K, Rowan K What patients think about ICU follow up services: a qualitative study. Crit Care 2009; 13: 2 10.1186/cc7769 PMC2689490 19338653 · DOI
  8. [11]Jones C, Griffiths RD Long-term outcome from critical illness. Anaesth Intensive Care Med 2006; 7: 155– 6. 10.1383/anes.2006.7.1.5 · DOI
  9. [12]Jones C, Griffiths RD, Humphris G Memory, delusions and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 2001; 29: 573– 80. 10.1097/00003246-200103000-00019 11373423 · DOI
  10. [13]Kynoch K, Paxton J, Chang A ICU nurses’ experiences and perspectives of caring for obstetric patients in intensive care: a qualitative study. J Clin Nurs 2010; 20: 1768– 75. 10.1111/j.1365-2702.2010.03517.x 20958805 · DOI
  11. [14]Campbell PT, Rudisill PT Psychosocial needs of the critically ill obstetric patient. The nurse's role. Crit Care Nurs Q 2006; 29: 77– 80. 10.1097/00002727-200601000-00008 16456365 · DOI
  12. [15]Pollock W Caring for pregnant and postnatal women in intensive care: what do we know? Aust Crit Care 2006; 19: 54– 65. 10.1016/S1036-7314(06)80010-X 16764153 · DOI
  13. [16]Zeeman G, Sharawi N, O'Sullivan G Service organization: hospital and department. In: Van de Velde M, Scholefield H, Plante L, eds. Maternal critical care: a multidisciplinary approach. Cambridge: Cambridge University Press, 2013: 7– 15.
  14. [17]Scholefield H, Plante L Competency and personnel. In: Van de Velde M, Scholefield H, Plante L, eds. Maternal critical care: a multidisciplinary approach. Cambridge: Cambridge University Press, 2013: 16– 25.
  15. [18]Ziebland S Why listening to health care users really matters. J Health Serv Res Policy 2012; 17: 68– 9. 10.1258/jhsrp.2012.012025 22535900 · DOI
  16. [22]Fillippi VR, Gandaho T, Graham W Women's reports of severe (near-miss) obstetric complications in Benin. Stud Fam Plann 2000; 31: 309– 24. 10.1111/j.1728-4465.2000.00309.x 11198068 · DOI · Paper page
  17. [26]Elmir R, Schmeid V, Wilkes L Women's perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs 2010; 66: 2142– 53. 10.1111/j.1365-2648.2010.05391.x 20636467 · DOI · Paper page
  18. [27]Nystrom K, Axelsson K Mother's experiences of being separated from their newborns. J Obstet Gynecol Neonatal Nurs 2002; 31: 275– 82. 10.1111/j.1552-6909.2002.tb00049.x 12033540 · DOI
  19. [28]Fenwick J, Barclay L, Schmeid V Craving closeness: a grounded theory analysis of women's experiences of mothering in the special care nursery. Women Birth 2008; 21: 71– 85. 10.1016/j.wombi.2008.03.006 18463016 · DOI
  20. [29]Lupton D, Fenwick J ‘They've forgotten that I'm the mum’: constructing and practicing motherhood in special care nurseries. Soc Sci Med 2001; 53: 1011– 21. 10.1016/S0277-9536(00)00396-8 11556771 · DOI
  21. [30]Field K, Prinjha S, Rowan K ‘One patient amongst many’: a qualitative analysis of intensive care unit patients’ experiences of transferring to the general ward. Crit Care 2008; 12: R21 10.1186/cc6795 18294370 PMC2374598 · DOI
  22. [31]Lombard H, Seligman N Recovery from intensive care and the next pregnancy. In: Van de Velde M, Scholefield H, Plante L, eds. Maternal critical care: a multidisciplinary approach. Cambridge: Cambridge University Press, 2013: 78– 87.
  23. [32]Pollock W Rose L Dennis CL Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med 2010; 36: 1465– 74. 10.1007/s00134-010-1951-0 20631987 · DOI
  24. [33]Elmir R, Schmeid V, Wilkes L Separation, failure and temporary relinquishment: women's experiences of early mothering in the context of emergency hysterectomy. J Clin Nurs 2011; 21: 1119– 27. 10.1111/j.1365-2702.2011.03913.x 22176681 · DOI
  25. [35]Meltzer-Brody S New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci 2011; 13: 89– 100. 21485749 PMC3181972
  26. [36]American College of Obstetrics and Gynaecology. Practice Bulletin 92: clinical management guidelines for obstetrician-gynaecologists number 92, April 2008: use of psychiatrics medications during pregnancy and lactation. Obstet Gynecol 2008; 111: 1001– 20. 10.1097/AOG.0b013e31816fd910 18378767 · DOI
  27. [37]Desai SV, Law TJ, Needham DM Long term complications of critical care. Crit Care Med 2009; 3 (Suppl): S309– 19. 20959786
  28. [38]Neligan P, Laffey J Clinical review: special populations—critical illness and pregnancy. Crit Care 2011; 15: 227 10.1186/cc10256 21888683 PMC3387584 · DOI
  29. [39]Plaat F, Naik M Critical care in pregnancy. Crit Care 2011; 15: 1014 10.1186/cc10479 22236812 PMC3388691 · DOI
  30. [40]Bench S Recognition and management of critical illness by midwives: implications for service provision. J Nurs Manag 2007; 15: 348– 56. 10.1111/j.1365-2834.2007.00759.x 17359435 · DOI

Cited by

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Authors
Hinton, L., Locock, L., & Knight, M.
Affiliations
University of Oxford (GB)
Corresponding author
Hinton, Lisa
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2015-04
Volume
5
Issue
4
Pages
e006676
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2014-006676
PMC
PMC4420959
OpenAlex
W2036680045
Cited by
62
References
2
Citations by year
2026: 8 · 2025: 6 · 2024: 8 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 5 · 2019: 6 · 2018: 7 · 2017: 1 · 2016: 2 · 2015: 2
FWCI
3.99
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
Funders
National Institute for Health and Care Research (RP-PG-0608-10038, NIHR-RP-011-032, Programme Grant RP-PG-0608-10038, 10038)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
Keywords
maternal critical care, severe maternal morbidity, maternal near miss, patient experience, intensive care unit, high dependency unit, maternal separation, breastfeeding support, care transitions, post-discharge follow-up, postpartum women
MeSH terms
Adult, Critical Care, Female, United Kingdom, Humans, Obstetric Labor Complications, Male, Maternal Health Services, Mother-Child Relations, Mothers, Pregnancy, Surveys and Questionnaires, Critical Illness, Spouses, Qualitative Research, Young Adult

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