Hinton Lisa, Locock Louise, Knight Marian
Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK NIHR Oxford Biomedical Research Centre, Oxford, UK.
BMJ Open. 2015 Apr 27;5(4):e006676. doi: 10.1136/bmjopen-2014-006676.
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.
Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity.
A qualitative study, using semistructured interviews.
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.
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.
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.
每发生一例孕产妇死亡，就有九名妇女会出现严重的孕产妇发病情况。这些妇女中的许多人将需要在重症监护病房（ICU）或高依赖病房（HDU）接受护理。孕期的重症护理对医护人员和患者来说都存在一些特殊问题，例如母乳喂养支持以及与新生儿分离等问题。本研究旨在了解经历过孕产妇险些死亡且产后需要重症护理的妇女的经历。
作为一项关于孕产妇险些发病经历研究的一部分，对来自英国各地的妇女及其部分伴侣进行了访谈。
一项采用半结构式访谈的定性研究。
招募了一个最大差异样本，包括35名妇女以及11名经历过严重孕产妇疾病的妇女的伴侣，若不及时就医，这些疾病本可能导致她们死亡。其中18名妇女被收治到ICU或HDU。
研究结果呈现为三个主题：接受重症护理；作为重症护理中的新妈妈；重症护理后的转院及随访。该研究凸显了新妈妈们对需要重症护理的震惊，以及她们对分娩的期望与实际发生情况之间的巨大差距；与婴儿分离的痛苦，若有可能接触新生儿的重要性，以及母乳喂养的重要性；转院的困难以及对更多支持的需求；随访及外展服务对这群重症护理患者的价值。
虽然孕期重症疾病并不常见，但对新妈妈来说可能是毁灭性的，对重症护理和产科医护人员也是一项挑战。本研究深入探讨了这些挑战，并根据患者经历提出了克服这些挑战的建议。
